Provider Demographics
NPI:1245265883
Name:SOUTH SOUND PHYSICAL & HAND THERAPY LLC
Entity type:Organization
Organization Name:SOUTH SOUND PHYSICAL & HAND THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:O'KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:425-316-8046
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:6981 LITTLEROCK RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7226
Practice Address - Country:US
Practice Address - Phone:360-352-7352
Practice Address - Fax:360-352-7680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SOUND PHYSICAL & HAND THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225XH1200X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3583413-01OtherOWCP