Healthcare Provider Details

I. General information

NPI: 1053545319
Provider Name (Legal Business Name): PAIN SCIENCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15511 3RD AVE SW
BURIEN WA
98166-2531
US

IV. Provider business mailing address

15511 3RD AVE SW
BURIEN WA
98166-2531
US

V. Phone/Fax

Practice location:
  • Phone: 206-327-9880
  • Fax: 206-327-9977
Mailing address:
  • Phone: 206-327-9880
  • Fax: 206-327-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00010537
License Number StateWA

VIII. Authorized Official

Name: DR. ORIT STEPHANIE HICKMAN
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 206-327-9880