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General NPI Number Information
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NPI Number | 1033571989
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Entity Type | Organization
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Legal Business Name | PUGET SOUND PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/21/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 3201 WILLAMETTE DR NE SUITE C
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City | LACEY
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State | WA
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Zip | 98516-1376
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Country | US
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Telephone | 321-401-1361
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Fax | 407-390-1765
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Provider Business Mailing Address
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Address Line | 3201 WILLAMETTE DR NE SUITE C
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City | LACEY
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State | WA
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Zip | 98516-1376
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Country | US
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Telephone | 321-401-1361
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Fax | 407-390-1765
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER DICKERSON
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Credential | DPT
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Telephone | 360-438-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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