MEDICARE: THERAPY MANAGEMENT SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	225100000X	Physical Therapist	WA
2	332BC3200X	Customized Equipment (DME)
3	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982766440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY MANAGEMENT SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	813-560-8157
Fax Number	:	425-452-0704

Provider Business Practice Location Address
First Line	:	400 MAIN AVE S
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8215
Country	:	US
Telephone Number	:	425-888-1156
Fax Number	:	425-888-6167

Authorized Official
Title or Position	:	CC
Name	:	DWAN DIAZ
Credential	:
Telephone Number	:	813-560-8157

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/30/2022

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