Provider Demographics
NPI:1912245192
Name:ANDREW EISEN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ANDREW EISEN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-855-1305
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-0730
Mailing Address - Country:US
Mailing Address - Phone:425-374-8383
Mailing Address - Fax:425-322-4421
Practice Address - Street 1:4649 SUNNYSIDE AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6900
Practice Address - Country:US
Practice Address - Phone:206-588-0855
Practice Address - Fax:206-588-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60046366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty