Healthcare Provider Details

I. General information

NPI: 1629388616
Provider Name (Legal Business Name): UNION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 BRIDGE WAY N SUITE 202
SEATTLE WA
98103-7951
US

IV. Provider business mailing address

PO BOX 1510
LAKE STEVENS WA
98258-1510
US

V. Phone/Fax

Practice location:
  • Phone: 206-819-4002
  • Fax: 206-322-4461
Mailing address:
  • Phone: 360-223-2807
  • Fax: 206-322-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 00009618
License Number StateWA

VIII. Authorized Official

Name: MR. MITCHELL GOUGH OWENS JR.
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 206-819-4002