Provider Demographics
NPI:1871827444
Name:MVP PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MVP PHYSICAL THERAPY, INC.
Other - Org Name:MVP PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DSC, MHS, PT
Authorized Official - Phone:253-564-1560
Mailing Address - Street 1:4040 ORCHARD ST. W.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:14800 STARFIRE WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-267-7811
Practice Address - Fax:206-267-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082225Medicaid
WA7082225Medicaid
WAGAB13912Medicare PIN