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General NPI Number Information
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NPI Number | 1538550926
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Entity Type | Organization
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Legal Business Name | PHENIX PHYSICAL THERAPY & PERSONAL WELLNESS, LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 1301 4TH AVE NW SUITE 300
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City | ISSAQUAH
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State | WA
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Zip | 98027-9371
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Country | US
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Telephone | 425-395-7317
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Fax | 425-395-7319
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Provider Business Mailing Address
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Address Line | 1301 4TH AVE NW SUITE 300
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City | ISSAQUAH
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State | WA
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Zip | 98027-9371
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Country | US
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Telephone | 425-395-7317
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Fax | 425-395-7319
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Authorized Official
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Title or Position | CEO/PHYSICAL THERAPIST
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Name | REID M KUETHER
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Credential | MPT, OCS
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Telephone | 206-713-6249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00012293
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00007633
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License Number State | WA
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