Healthcare Provider Details

I. General information

NPI: 1194943381
Provider Name (Legal Business Name): ADULT REHABILITATION THERAPIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31200 23RD AVE SOUTH SUITE 100
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

PO BOX 6225
FEDERAL WAY WA
98063
US

V. Phone/Fax

Practice location:
  • Phone: 253-839-3403
  • Fax: 253-839-3412
Mailing address:
  • Phone: 253-839-3403
  • Fax: 253-839-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number602023026
License Number StateWA

VIII. Authorized Official

Name: MR. JAMES C FULLER
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 253-839-3403