Healthcare Provider Details

I. General information

NPI: 1548460090
Provider Name (Legal Business Name): NORTHSHORE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18107 BOTHELL WAY NE SUITE 106
BOTHELL WA
98011-1900
US

IV. Provider business mailing address

18107 BOTHELL WAY NE SUITE 106
BOTHELL WA
98011-1900
US

V. Phone/Fax

Practice location:
  • Phone: 425-487-3142
  • Fax:
Mailing address:
  • Phone: 425-487-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VII. Legacy identifiers

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

# 1
IdentifierGAB10944
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerGROUP NUMBER

VIII. Authorized Official

Name: MR. CHRISTINE TEAGUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-487-3142