Basic Information
| Provider Information | |||||||||
| NPI: | 1245696814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNOHOMISH PHYSICAL THERAPY PLLC | ||||||||
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| OtherOrganizationName: | IRG PHYSICAL THERAPY OF CANYON PARK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22910 BOTHELL EVERETT HWY STE 107 | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980219327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256867656 | ||||||||
| FaxNumber: | 4253419054 | ||||||||
| Practice Location | |||||||||
| Address1: | 22910 BOTHELL EVERETT HWY | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980219327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256867656 | ||||||||
| FaxNumber: | 4253419054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2016 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | WA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.