Basic Information
| Provider Information | |||||||||
| NPI: | 1982663498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLYMPIC PHYSICAL THERAPY OF BELLEVUE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254552630 | ||||||||
| FaxNumber: | 4254514390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1188 106TH AVE NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980048614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254552630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | POST | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4254544864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7047731 | 05 | WA | MEDICAID |