=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306076385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY ESSENTIALS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2009
-----------------------------------------------------
Last Update Date | 07/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 112TH AVE NE D-154
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-644-9778
-----------------------------------------------------
Fax | 425-644-6448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 112TH AVE NE D-154
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-644-9778
-----------------------------------------------------
Fax | 425-644-6448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. HILARY JANE CROFT
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 425-644-9778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 00010425
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------