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General NPI Number Information
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NPI Number | 1205903390
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Entity Type | Organization
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Legal Business Name | WEST CAMPUS SPORT & ORTHOPEDIC PHYSICAL PS INC.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 505 S 336TH ST STE 140
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-874-6620
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Fax | 253-874-2542
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Provider Business Mailing Address
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Address Line | 505 S 336TH ST STE 140
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5946
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Country | US
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Telephone | 253-874-6620
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Fax | 253-874-2542
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | ANN M TAYLOR
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Credential |
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Telephone | 253-874-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00002979
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License Number State | WA
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