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General NPI Number Information
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NPI Number | 1558618322
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Entity Type | Organization
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Legal Business Name | VILLAGE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/10/2012
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 5417 IVANHOE PL NE
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City | SEATTLE
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State | WA
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Zip | 98105-2838
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Country | US
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Telephone | 206-498-8496
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Fax |
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Provider Business Mailing Address
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Address Line | 5124 NE LATIMER PL
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City | SEATTLE
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State | WA
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Zip | 98105-4954
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Country | US
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Telephone | 206-498-8496
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEANNA E IRWIN-SIRES
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Credential | PT, MPT, OCS
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Telephone | 206-498-8496
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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 | 00006079
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License Number State | WA
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