Healthcare Provider Details

I. General information

NPI: 1245696814
Provider Name (Legal Business Name): SNOHOMISH PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22910 BOTHELL EVERETT HWY SUITE 107
BOTHELL WA
98021-9327
US

IV. Provider business mailing address

22910 BOTHELL EVERETT HWY STE 107
BOTHELL WA
98021-9327
US

V. Phone/Fax

Practice location:
  • Phone: 425-686-7656
  • Fax: 425-341-9054
Mailing address:
  • Phone: 425-686-7656
  • Fax: 425-341-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP/AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000