Healthcare Provider Details

I. General information

NPI: 1568669406
Provider Name (Legal Business Name): CORE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 2ND AVE STE 100
SEATTLE WA
98121-1464
US

IV. Provider business mailing address

720 OLIVE WAY STE 900
SEATTLE WA
98101-1840
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-4020
  • Fax: 206-443-3999
Mailing address:
  • Phone: 206-623-2220
  • Fax: 206-623-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL DE BEIJL
Title or Position: OWNER
Credential: PT, LAC
Phone: 206-623-2220