Healthcare Provider Details

I. General information

NPI: 1790743003
Provider Name (Legal Business Name): MVP PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 MERIDIAN E STE A
PUYALLUP WA
98373
US

IV. Provider business mailing address

4040 ORCHARD ST. W. SUITE 100
FIRCREST WA
98466
US

V. Phone/Fax

Practice location:
  • Phone: 253-770-1807
  • Fax: 951-973-7216
Mailing address:
  • Phone: 253-564-1560
  • Fax: 253-564-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name: MARGARITA R MOORE
Title or Position: CREDENTIALING AND PROVIDER SERVICES
Credential:
Phone: 951-696-9353