MEDICARE: AUBURN SPORTS 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1619152469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUBURN SPORTS PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	801 AUBURN WAY N
Second Line	:	SUITE E
City	:	AUBURN
State	:	WA
Zip	:	98002-4164
Country	:	US
Telephone Number	:	253-736-2340
Fax Number	:	253-736-2343

Provider Business Practice Location Address
First Line	:	801 AUBURN WAY N
Second Line	:	SUITE E
City	:	AUBURN
State	:	WA
Zip	:	98002-4164
Country	:	US
Telephone Number	:	253-736-2340
Fax Number	:	253-736-2343

Authorized Official
Title or Position	:	ONWER PT
Name	:	MR. JOEL M JOHNSON
Credential	:	PT
Telephone Number	:	253-736-2340

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	07/13/2016

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