Healthcare Provider Details

I. General information

NPI: 1710384953
Provider Name (Legal Business Name): GO PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 YALE AVE N
SEATTLE WA
98109
US

IV. Provider business mailing address

201 YALE AVE N
SEATTLE WA
98109-5430
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-7602
  • Fax: 206-624-7606
Mailing address:
  • Phone: 206-624-7602
  • Fax: 206-624-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT60289375
License Number StateWA

VIII. Authorized Official

Name: MICHAEL DOMINGO
Title or Position: OWNER, CEO
Credential: DPT
Phone: 352-613-4658