Provider Demographics
NPI:1457353609
Name:REAL REHAB, PLLC
Entity Type:Organization
Organization Name:REAL REHAB, PLLC
Other - Org Name:REAL REHAB PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-706-7500
Mailing Address - Street 1:9725 3RD AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2060
Mailing Address - Country:US
Mailing Address - Phone:206-706-7500
Mailing Address - Fax:206-706-7890
Practice Address - Street 1:9725 3RD AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2060
Practice Address - Country:US
Practice Address - Phone:206-706-7500
Practice Address - Fax:206-706-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602134577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115637Medicaid
WA7115637Medicaid