Provider Demographics
NPI:1154377240
Name:ABC PHYSICAL THERAPY
Entity type:Organization
Organization Name:ABC PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:253-564-2220
Mailing Address - Street 1:2315 6TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1050
Mailing Address - Country:US
Mailing Address - Phone:253-564-2220
Mailing Address - Fax:253-564-2221
Practice Address - Street 1:2315 6TH AVE.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1050
Practice Address - Country:US
Practice Address - Phone:253-564-2220
Practice Address - Fax:253-564-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225700000X
WAPT00006703261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0147781OtherDEPARTMENT OF L&I
WA7189050OtherAETNA
WA2063203001OtherCIGNA
WA7106180OtherDSHS
WA5356FOOtherREGENCE BLUE SHIELD
WA7106180Medicaid
WA4675150001Medicare NSC
WA7106180OtherDSHS