Basic Information
| Provider Information | |||||||||
| NPI: | 1487692398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNOHOMISH PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 BICKFORD AVE STE 209 | ||||||||
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| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982901750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605687774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1830 BICKFORD AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | SNOHOMISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605687774 | ||||||||
| FaxNumber: | 3605687779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| 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 | 225700000X | WA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225XH1200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 3158SN | 01 | WA | REGENCE BLUESHIELD GRP # | OTHER | 7119167 | 05 | WA | MEDICAID | 0175764 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | DA5809 | 01 | WA | RAILROAD MEDICARE | OTHER | 8932322 | 01 | WA | L&I CRIME VICTIMS | OTHER | 1028001-00 | 01 | WA | OWCP | OTHER | 9054990 | 05 | WA | MEDICAID |