MEDICARE: DEXTER PHYSICAL THERAPY

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	00008614	WA

General Provider Information

NPI Number	:	1609385947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEXTER PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	4758 23RD AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1314
Country	:	US
Telephone Number	:	206-491-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4758 23RD AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1314
Country	:	US
Telephone Number	:	206-491-7193
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	JODY DEXTER
Credential	:	PT
Telephone Number	:	206-491-7193

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	07/21/2022

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Directions to “DEXTER PHYSICAL THERAPY ” Practice Location

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