MEDICARE: SEA PINES PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0291064	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730785833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA PINES PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	3724 WALNUT AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3838
Country	:	US
Telephone Number	:	206-953-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3724 WALNUT AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3838
Country	:	US
Telephone Number	:	206-953-0348
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	STEPHANIE HOLLOWAY
Credential	:
Telephone Number	:	206-953-0348

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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