Provider Demographics
NPI:1881998482
Name:EMERALD CITY PHYSICAL THERAPY SVCS, LLC
Entity type:Organization
Organization Name:EMERALD CITY PHYSICAL THERAPY SVCS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:SCHONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:206-755-9995
Mailing Address - Street 1:6500 6TH AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5099
Mailing Address - Country:US
Mailing Address - Phone:206-755-9995
Mailing Address - Fax:
Practice Address - Street 1:6500 6TH AVE NW STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5099
Practice Address - Country:US
Practice Address - Phone:206-755-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty