Healthcare Provider Details

I. General information

NPI: 1215975248
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 LITTLEROCK RD SW SUITE 103
TUMWATER WA
98512-7332
US

IV. Provider business mailing address

6334 LITTLEROCK RD SW SUITE 103
TUMWATER WA
98512-7332
US

V. Phone/Fax

Practice location:
  • Phone: 360-786-0878
  • Fax: 360-786-0884
Mailing address:
  • Phone: 360-786-0878
  • Fax: 360-786-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAYNE FLECK-POOL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 469-467-8705