Healthcare Provider Details

I. General information

NPI: 1275766172
Provider Name (Legal Business Name): STRETCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 YALE AVE N
SEATTLE WA
98109-5430
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number602622922
License Number StateWA

VIII. Authorized Official

Name: MR. WOLFGANG E BROLLEY
Title or Position: OWNER/FOUNDER
Credential: RPT,LMP,RC
Phone: 206-624-7602