Basic Information
| Provider Information | |||||||||
| NPI: | 1679574479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLEX PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 NE 180TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980115773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254834270 | ||||||||
| FaxNumber: | 4254834268 | ||||||||
| Practice Location | |||||||||
| Address1: | 12900 NE 180TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980115773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254834270 | ||||||||
| FaxNumber: | 4254834268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GADDIS | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4254834270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P. T | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7116486 | 05 | WA | MEDICAID |