Provider Demographics
NPI:1356415756
Name:PT & OT OF WASHINGTON, LLC
Entity type:Organization
Organization Name:PT & OT OF WASHINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-367-5853
Mailing Address - Street 1:20310 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1261
Mailing Address - Country:US
Mailing Address - Phone:206-367-5853
Mailing Address - Fax:
Practice Address - Street 1:20310 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1261
Practice Address - Country:US
Practice Address - Phone:206-367-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy