Healthcare Provider Details

I. General information

NPI: 1740864982
Provider Name (Legal Business Name): 520 PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13112 NE 20TH ST STE 400
BELLEVUE WA
98005-2045
US

IV. Provider business mailing address

26431 233RD AVE SE
MAPLE VALLEY WA
98038
US

V. Phone/Fax

Practice location:
  • Phone: 206-693-9929
  • Fax: 206-922-8909
Mailing address:
  • Phone: 206-693-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALSTON ZACHARY SMITH
Title or Position: CO-OWNER
Credential: DPT
Phone: 206-693-9929