Provider Demographics
NPI:1700108289
Name:OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION INC PC
Entity Type:Organization
Organization Name:OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-413-4427
Mailing Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:STE 201
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-9917
Mailing Address - Country:US
Mailing Address - Phone:425-413-4427
Mailing Address - Fax:
Practice Address - Street 1:27005 168TH PL SE
Practice Address - Street 2:STE 200
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4902
Practice Address - Country:US
Practice Address - Phone:253-639-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11700OtherMEDICARE PTAN
WA7086606Medicaid
WA7086606Medicaid