MEDICARE: CORE PHYSICAL THERAPY PC

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	171100000X	Acupuncturist
2	261QP2000X	Physical Therapy Clinic/Center	PT00005321	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	144285	OTHER	WA	DEPT OF LABOR & IND

General Provider Information

NPI Number	:	1356411011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	720 OLIVE WAY STE 900
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1840
Country	:	US
Telephone Number	:	206-623-2220
Fax Number	:	206-623-2228

Provider Business Practice Location Address
First Line	:	720 OLIVE WAY STE 900
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1840
Country	:	US
Telephone Number	:	206-623-2220
Fax Number	:	206-623-2228

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL DE BEIJL
Credential	:	PT, L.AC
Telephone Number	:	206-623-2220

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	09/05/2024

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