Healthcare Provider Details

I. General information

NPI: 1063827772
Provider Name (Legal Business Name): RESCARE REHAB WITHOUT WALLS OUTPATIENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6912 220TH ST SW SUITE 200
MOUNTLAKE TERRACE WA
98043-2169
US

IV. Provider business mailing address

6912 220TH ST SW SUITE 200
MOUNTLAKE TERRACE WA
98043-2169
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-2716
  • Fax:
Mailing address:
  • Phone: 425-672-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOT60437671
License Number StateWA

VIII. Authorized Official

Name: AMY MEYERS
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: OTR/L
Phone: 425-672-2716