Provider Demographics
NPI:1952986184
Name:PHYSIOWORKS SILVERDALE PLLC
Entity Type:Organization
Organization Name:PHYSIOWORKS SILVERDALE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, OTR/L
Authorized Official - Phone:425-879-3403
Mailing Address - Street 1:17526 163RD PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9131
Mailing Address - Country:US
Mailing Address - Phone:425-879-3403
Mailing Address - Fax:
Practice Address - Street 1:9399 RIDGETOP BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8580
Practice Address - Country:US
Practice Address - Phone:360-900-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation