=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033046370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATHLEMA PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2026
-----------------------------------------------------
Last Update Date | 05/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2749 152ND AVE NE BLDG 4H
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4524
-----------------------------------------------------
Fax | 844-574-1771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2749 152ND AVE NE BLDG 4H
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4524
-----------------------------------------------------
Fax | 844-574-1771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. YANNIS MAVROMMATAKIS
-----------------------------------------------------
Credential | PT, DPT, OCS, PHD
-----------------------------------------------------
Telephone | 425-395-4524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------