Healthcare Provider Details

I. General information

NPI: 1588275077
Provider Name (Legal Business Name): NORTHWEST ACTIVE HEALTH THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 37TH AVE S #251
SEATTLE WA
98118
US

IV. Provider business mailing address

3431 S 255TH ST
KENT WA
98032-9747
US

V. Phone/Fax

Practice location:
  • Phone: 425-753-5272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTIN HITCHCOCK
Title or Position: MEDICAL DIRECTOR
Credential: DPT
Phone: 425-753-5272