Provider Demographics
NPI:1457542466
Name:COLUMBIA PHYSICAL THERAPY SERVICES, INC,
Entity type:Organization
Organization Name:COLUMBIA PHYSICAL THERAPY SERVICES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:206-722-2205
Mailing Address - Street 1:3207 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6031
Mailing Address - Country:US
Mailing Address - Phone:206-722-2205
Mailing Address - Fax:206-722-5457
Practice Address - Street 1:3207 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6031
Practice Address - Country:US
Practice Address - Phone:206-722-2205
Practice Address - Fax:206-722-5457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA PHYSICAL THERAPY SERVICES, INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002400261QP2000X
WAPT00002391261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8918108OtherWASHINGTON STATE CRIME VI
WA7004690Medicaid
WA0072973OtherWA STATE LABOR & INDUSTRI
WA7004690Medicaid