Basic Information
| Provider Information | |||||||||
| NPI: | 1063635340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIRKLAND PHYSICAL THERAPY, INC., P.S. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NOVELTY HILL PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23515 NE NOVELTY HILL RD | ||||||||
| Address2: | SUITE B-213 | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980531996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258685260 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23515 NE NOVELTY HILL RD | ||||||||
| Address2: | SUITE B-213 | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980531996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258685260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 06/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHLEY | ||||||||
| AuthorizedOfficialFirstName: | TAMI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4258208474 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KIRKLAND PHYSICAL THERAPY, INC., P.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.