Healthcare Provider Details

I. General information

NPI: 1154377240
Provider Name (Legal Business Name): ABC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/30/2023
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 6TH AVE.
TACOMA WA
98403-1050
US

IV. Provider business mailing address

2315 6TH AVE.
TACOMA WA
98403-1050
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-2220
  • Fax: 253-564-2221
Mailing address:
  • Phone: 253-564-2220
  • Fax: 253-564-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00006703
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER NOEL FORD
Title or Position: OWNER
Credential: MPT
Phone: 253-564-2220