Healthcare Provider Details

I. General information

NPI: 1770894990
Provider Name (Legal Business Name): LAKE WASHINGTON PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 KIRKLAND AVE
KIRKLAND WA
98033-6503
US

IV. Provider business mailing address

209 KIRKLAND AVE
KIRKLAND WA
98033-6503
US

V. Phone/Fax

Practice location:
  • Phone: 425-466-4113
  • Fax:
Mailing address:
  • Phone: 425-629-3502
  • Fax: 425-629-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number602-993-744
License Number StateWA

VIII. Authorized Official

Name: SARA WOBKER
Title or Position: VICE PRESIDENT
Credential:
Phone: 425-629-3502