Provider Demographics
NPI:1902014418
Name:MILL CREEK PHYSICAL THERAPY & SPORTS REHAB, INC. P.S.
Entity Type:Organization
Organization Name:MILL CREEK PHYSICAL THERAPY & SPORTS REHAB, INC. P.S.
Other - Org Name:MILL CREEK PHYSICAL THERAPY & SPORTS REHAB, INC. P.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-745-4311
Mailing Address - Street 1:15808 MILL CREEK BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1500
Mailing Address - Country:US
Mailing Address - Phone:425-745-4311
Mailing Address - Fax:425-337-0705
Practice Address - Street 1:15808 MILL CREEK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-745-4311
Practice Address - Fax:425-337-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002603261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0036785OtherLABOR & INDUSTRIES
WA0036785OtherLABOR & INDUSTRIES