=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750801817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPY MANAGEMENT SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2017
-----------------------------------------------------
Last Update Date | 03/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17924 140TH AVE NE STE 200
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-658-0110
-----------------------------------------------------
Fax | 425-658-5310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 118TH AVE SE STE 110
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-3875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-450-9474
-----------------------------------------------------
Fax | 425-452-0704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | DWAN DIAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-450-9474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251H1200X
-----------------------------------------------------
Taxonomy Name | Hand Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------