Provider Demographics
NPI:1952394546
Name:MARYSVILLE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MARYSVILLE PHYSICAL THERAPY, INC.
Other - Org Name:NORTHSOUND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HEDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-629-7528
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:9516 STATE AVE
Practice Address - Street 2:STE. B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2277
Practice Address - Country:US
Practice Address - Phone:360-658-8857
Practice Address - Fax:360-659-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA118546OtherDEPT OF L&I GROUP #
WANO5342OtherREGENCE BLUE SHIELD GRP#
WA8933936OtherDEPT OF L&I CRIME VICTIMS
WA7091077Medicaid
WA8933936OtherDEPT OF L&I CRIME VICTIMS