Healthcare Provider Details

I. General information

NPI: 1639701097
Provider Name (Legal Business Name): PT4YOU PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27043 8TH AVE S
DES MOINES WA
98198-9305
US

IV. Provider business mailing address

27043 8TH AVE S
DES MOINES WA
98198-9305
US

V. Phone/Fax

Practice location:
  • Phone: 253-765-5884
  • Fax: 253-765-5324
Mailing address:
  • Phone: 253-677-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARY EDGAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-206-6240