Healthcare Provider Details

I. General information

NPI: 1083112254
Provider Name (Legal Business Name): THERAPY MANAGEMENT SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 108TH AVE SE STE 100
KENT WA
98031-0108
US

IV. Provider business mailing address

915 118TH AVE SE STE 110
BELLEVUE WA
98005-3875
US

V. Phone/Fax

Practice location:
  • Phone: 425-917-9887
  • Fax: 253-277-0739
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. DWAN AYALA
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 425-450-9474