Healthcare Provider Details

I. General information

NPI: 1053322875
Provider Name (Legal Business Name): MARRAN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE SUITE #103
REDMOND WA
98052-3858
US

IV. Provider business mailing address

8301 161ST AVE NE SUITE #103
REDMOND WA
98052-3858
US

V. Phone/Fax

Practice location:
  • Phone: 425-284-1767
  • Fax: 425-284-3302
Mailing address:
  • Phone: 425-284-1767
  • Fax: 425-284-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number602049960
License Number StateWA

VIII. Authorized Official

Name: DOUGLAS RANK
Title or Position: OWNER
Credential: PT, ATC
Phone: 425-284-1767