Healthcare Provider Details

I. General information

NPI: 1598897001
Provider Name (Legal Business Name): COPPERSMITH ORTH & SPORTS PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE SUITE 201
SEATTLE WA
98105-4151
US

IV. Provider business mailing address

5025 25TH AVE NE SUITE 201
SEATTLE WA
98105-4151
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax: 206-524-6703
Mailing address:
  • Phone: 206-524-6702
  • Fax: 206-524-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00002380
License Number StateWA

VIII. Authorized Official

Name: PENNY S COPPERSMITH
Title or Position: PRESIDENT
Credential: PT
Phone: 206-524-6702