Healthcare Provider Details

I. General information

NPI: 1326513458
Provider Name (Legal Business Name): APPLEWHEAT-MVPT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22443 SE 240TH ST STE 201
MAPLE VALLEY WA
98038-5879
US

IV. Provider business mailing address

110 W 6TH AVE # 215
ELLENSBURG WA
98926-3106
US

V. Phone/Fax

Practice location:
  • Phone: 425-432-1671
  • Fax:
Mailing address:
  • Phone: 206-406-4527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00000000
Identifier TypeOTHER
Identifier State
Identifier IssuerN/A

VIII. Authorized Official

Name: DR. EMILY ANDREWS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 206-406-4527