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General NPI Number Information
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NPI Number | 1952394546
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Entity Type | Organization
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Legal Business Name | MARYSVILLE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9516 STATE AVE STE. B
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City | MARYSVILLE
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State | WA
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Zip | 98270-2277
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Country | US
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Telephone | 360-658-8857
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Fax | 360-659-8296
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Provider Business Mailing Address
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Address Line | 27500 102ND AVE NW STE 1
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City | STANWOOD
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State | WA
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Zip | 98292-8092
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Country | US
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Telephone | 360-629-7528
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Fax | 360-629-7632
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. KARL H. HEDEEN
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Credential | PT
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Telephone | 360-629-7528
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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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