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General NPI Number Information
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NPI Number | 1902643992
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Entity Type | Organization
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Legal Business Name | THERAPYDIA OF WASHINGTON PC
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 7604 NE 5TH AVE STE 109
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City | VANCOUVER
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State | WA
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Zip | 98665-8200
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Country | US
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Telephone | 616-483-3480
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Fax | 360-597-7848
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Provider Business Mailing Address
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Address Line | 625 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2395
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Country | US
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Telephone | 616-356-5000
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Fax | 616-356-5001
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Authorized Official
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Title or Position | CEO
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Name | RICHARD LEAVER
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Credential | PT
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Telephone | 616-356-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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