Healthcare Provider Details

I. General information

NPI: 1891838702
Provider Name (Legal Business Name): ALLIANCE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 336TH ST STE E
FEDERAL WAY WA
98023
US

IV. Provider business mailing address

34507 PACIFIC HWY S 6
FEDERAL WAY WA
98003
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-6611
  • Fax: 253-838-6789
Mailing address:
  • Phone: 253-838-6611
  • Fax: 253-838-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00003078
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN G WITTROCK
Title or Position: OWNER
Credential: PT
Phone: 253-838-2464