Provider Demographics
NPI:1922423623
Name:WEST SEATTLE PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:WEST SEATTLE PEDIATRIC THERAPIES
Other - Org Name:WSPT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FITTERER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PCS
Authorized Official - Phone:206-913-3323
Mailing Address - Street 1:9661 50TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2722
Mailing Address - Country:US
Mailing Address - Phone:206-913-3323
Mailing Address - Fax:206-770-6290
Practice Address - Street 1:9661 50TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-2722
Practice Address - Country:US
Practice Address - Phone:206-913-3323
Practice Address - Fax:206-770-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA98642251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty