MEDICARE: FOUNDATIONS THERAFITNESS AND PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1083239073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS THERAFITNESS AND PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	6028 TIGER TAIL DR SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-2141
Country	:	US
Telephone Number	:	360-584-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 BLACK LAKE BLVD SW STE 103
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5634
Country	:	US
Telephone Number	:	360-584-4556
Fax Number	:	360-251-0011

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, CEO
Name	:	TRACEE JEAN MARTIN KARLSON
Credential	:	PT
Telephone Number	:	360-584-4556

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	01/09/2023

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