Healthcare Provider Details

I. General information

NPI: 1861450173
Provider Name (Legal Business Name): MVP PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32129 WEYERHAEUSER WAY S
FEDERAL WAY WA
98001-9801
US

IV. Provider business mailing address

4040 ORCHARD ST W STE 100
FIRCREST WA
98466-6610
US

V. Phone/Fax

Practice location:
  • Phone: 253-815-1117
  • Fax: 253-815-1107
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA LITT
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 951-696-9353