Healthcare Provider Details

I. General information

NPI: 1255790374
Provider Name (Legal Business Name): PREMIER THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21827 76TH AVE W SUITE 101
EDMONDS WA
98026-7981
US

IV. Provider business mailing address

18610 88TH AVE W
EDMONDS WA
98026-5710
US

V. Phone/Fax

Practice location:
  • Phone: 206-554-1216
  • Fax:
Mailing address:
  • Phone: 206-554-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00006784
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT60242053
License Number StateWA

VIII. Authorized Official

Name: J. RANKIN THOMPSON
Title or Position: CO-OWNER
Credential: DPT
Phone: 206-554-1216