Provider Demographics
NPI:1891838702
Name:ALLIANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY LLC
Other - Org Name:TWIN LAKES PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WITTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-838-2464
Mailing Address - Street 1:34507 PACIFIC HWY S
Mailing Address - Street 2:6
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-838-6611
Mailing Address - Fax:253-838-6789
Practice Address - Street 1:2500 SW 336TH ST
Practice Address - Street 2:STE E
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023
Practice Address - Country:US
Practice Address - Phone:253-838-6611
Practice Address - Fax:253-838-6789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000030782251X0800X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7099658Medicaid
WAGAB12173Medicare UPIN
WAAB12173Medicare ID - Type UnspecifiedMEDICARE CLINIC NUMBER