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General NPI Number Information
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NPI Number | 1790968766
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Entity Type | Organization
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Legal Business Name | MAPLE VALLEY PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 23870 SE KENT KANGLEY RD
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-6848
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Country | US
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Telephone | 425-432-1671
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Fax | 425-432-1677
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Provider Business Mailing Address
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Address Line | 22443 SE 240 ST SUITE 201
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City | MAPLE VALLEY
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State | WA
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Zip | 98038
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Country | US
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Telephone | 425-432-1671
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Fax | 425-432-1677
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLIFFORD JOHN RICHARDS
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Credential | PT
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Telephone | 425-432-1671
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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 | 5147
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License Number State | WA
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