MEDICARE: MVP PHYSICAL THERAPY, INC.

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	225100000X	Physical Therapist		WA

General Provider Information

NPI Number	:	1376501643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVP PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	4040 ORCHARD ST. W.
Second Line	:	SUITE 100
City	:	FIRCREST
State	:	WA
Zip	:	98466
Country	:	US
Telephone Number	:	253-564-1560
Fax Number	:	253-564-4449

Provider Business Practice Location Address
First Line	:	451 SW SEDGWICK RD.
Second Line	:	SUITE 310
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367
Country	:	US
Telephone Number	:	360-874-8009
Fax Number	:	360-874-8010

Authorized Official
Title or Position	:	CEO/PHYSICAL THERAPIST
Name	:	PATRICK GARLOCK
Credential	:	DSC, MHS, PT
Telephone Number	:	253-564-1560

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/09/2018

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