Provider Demographics
NPI:1205903390
Name:WEST CAMPUS SPORT & ORTHOPEDIC PHYSICAL PS INC.
Entity type:Organization
Organization Name:WEST CAMPUS SPORT & ORTHOPEDIC PHYSICAL PS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-874-6620
Mailing Address - Street 1:505 S 336TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5946
Mailing Address - Country:US
Mailing Address - Phone:253-874-6620
Mailing Address - Fax:253-874-2542
Practice Address - Street 1:505 S 336TH ST STE 140
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-874-6620
Practice Address - Fax:253-874-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346322Medicaid
WA09521OtherL&I
WAAB15796Medicare UPIN