Healthcare Provider Details

I. General information

NPI: 1245265883
Provider Name (Legal Business Name): SOUTH SOUND PHYSICAL & HAND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6981 LITTLEROCK RD SW SUITE 105
TUMWATER WA
98512-7226
US

IV. Provider business mailing address

1519 132ND ST SE SUITE A
EVERETT WA
98208-7203
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-7352
  • Fax: 360-352-7680
Mailing address:
  • Phone: 425-357-9380
  • Fax: 425-357-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHANNON O'KELLEY
Title or Position: PRESIDENT/OWNER
Credential: MPT
Phone: 425-316-8046