Healthcare Provider Details

I. General information

NPI: 1356415756
Provider Name (Legal Business Name): PT & OT OF WASHINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20310 19TH AVE NE
SHORELINE WA
98155-1261
US

IV. Provider business mailing address

20310 19TH AVE NE
SHORELINE WA
98155-1261
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-5853
  • Fax:
Mailing address:
  • Phone: 206-367-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY L WHITE
Title or Position: MEMBER
Credential:
Phone: 206-367-5853