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NPI Code Detail

MEDICARE: COPPERSMITH ORTH & SPORTS PT

MEDICARE: COPPERSMITH ORTH & SPORTS PT
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
1261QP2000XPhysical Therapy Clinic/CenterPT00002380WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1911891680OTHERWAPREMERA BLUE CROSS
2911891680OTHERWAUNIFORM MEDICAL
3911891680OTHERWAPHCS
4911891680OTHERWAAETNA
5911891680OTHERWAUNITED HEALTHCARE
6911891680OTHERWAFIRST CHOICE

General Provider Information

NPI Number : 1598897001
Entity Type Code : Organization
Provider Name (Legal Business Name) : COPPERSMITH ORTH & SPORTS PT
Provider Business Mailing Address
First Line : 5025 25TH AVE NE
Second Line : SUITE 201
City : SEATTLE
State : WA
Zip : 98105-4151
Country : US
Telephone Number : 206-524-6702
Fax Number : 206-524-6703
Provider Business Practice Location Address
First Line : 5025 25TH AVE NE
Second Line : SUITE 201
City : SEATTLE
State : WA
Zip : 98105-4151
Country : US
Telephone Number : 206-524-6702
Fax Number : 206-524-6703
Authorized Official
Title or Position : PRESIDENT
Name : PENNY S COPPERSMITH
Credential : PT
Telephone Number : 206-524-6702
Provider Enumeration Date : 03/10/2007
Last Update Date : 05/18/2015

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1417281874 — MRS. ELIZABETH B SPINRAD DPT
Practice Location Address:
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98105-4151
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Practice Fax: 206-524-6703

Directions to “COPPERSMITH ORTH & SPORTS PT ” Practice Location

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