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General NPI Number Information
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NPI Number | 1447341946
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Entity Type | Organization
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Legal Business Name | ACTIVE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 1415 W DRAVUS ST
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City | SEATTLE
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State | WA
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Zip | 98119-1716
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Country | US
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Telephone | 206-284-9088
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Fax | 206-285-4946
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Provider Business Mailing Address
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Address Line | 1415 W DRAVUS ST
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City | SEATTLE
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State | WA
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Zip | 98119-1716
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Country | US
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Telephone | 206-284-9088
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Fax | 206-285-4946
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTENEY J BEALKO
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Credential | PT, CERT. MDT, CSCS
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Telephone | 206-284-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT00008630
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License Number State | WA
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