Healthcare Provider Details

I. General information

NPI: 1295039352
Provider Name (Legal Business Name): GREEN GRASS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 N 45TH ST SUITE 202
SEATTLE WA
98103-6982
US

IV. Provider business mailing address

2319 N 45TH ST SUITE 202
SEATTLE WA
98103-6982
US

V. Phone/Fax

Practice location:
  • Phone: 206-910-9590
  • Fax:
Mailing address:
  • Phone: 206-910-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00010361
License Number StateWA

VIII. Authorized Official

Name: DR. SOUNDUS MACHTLEY
Title or Position: PRESIDENT
Credential: PT, DPT, OCS, MTC
Phone: 206-910-9590