Healthcare Provider Details

I. General information

NPI: 1548217631
Provider Name (Legal Business Name): SOUTH SOUND PHYSICAL & HAND THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARKET ST NE SUITE 108
OLYMPIA WA
98501-1008
US

IV. Provider business mailing address

4220 132ND ST SE SUITE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-7085
  • Fax: 360-754-3671
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHANNON O'KELLEY
Title or Position: PRESIDENT/OWNER
Credential: MPT
Phone: 425-316-8046