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General NPI Number Information
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NPI Number | 1467834762
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Entity Type | Organization
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Legal Business Name | RAVENNA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 2612 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-1214
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Country | US
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Telephone | 206-686-4073
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Fax | 206-260-4565
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Provider Business Mailing Address
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Address Line | 2612 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-1214
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Country | US
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Telephone | 206-686-4073
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Fax | 206-260-4565
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | LAURA BANNISTER
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Credential | DPT
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Telephone | 206-686-4073
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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 | PT00009881
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License Number State | WA
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