MEDICARE: MTI PHYSICAL THERAPY MAGNOLIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		WA

General Provider Information

NPI Number	:	1871711051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MTI PHYSICAL THERAPY MAGNOLIA

Provider Business Mailing Address
First Line	:	3200 W MCGRAW ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 W MCGRAW ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3208
Country	:	US
Telephone Number	:	206-281-7970
Fax Number	:

Authorized Official
Title or Position	:	PT CLINIC DIRECTOR
Name	:	MR. DAVE SELF
Credential	:	PT
Telephone Number	:	206-281-7970

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/21/2022

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