# ORTHOSPORT PHYSICAL THERAPY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750471538
- **Authorized official:** THOMAS DIANGELIS PT, DPT (OWNER)
- **Authorized official phone:** (425) 670-9991

## Contact information

- **Practice address:** 19217 36TH AVE W, SUITE 102, LYNNWOOD, WA 98036-5751
- **Practice address phone:** (425) 670-9991
- **Practice address fax:** (425) 670-9995
- **Mailing address:** 19217 36TH AVE W, SUITE 102, LYNNWOOD, WA 98036-5751
- **Mailing address phone:** (425) 670-9991
- **Mailing address fax:** (425) 670-9995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | PT00002005 | WA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/13/2006
- **Last updated:** 12/18/2015