Organization
LAKE SAMMAMISH PHYSICAL THERAPY, PLLC
Active
Other names
Lake Sammamish Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DWAN DIAZ (CREDENTIALING COORDINATOR)
(425) 450-9474
Entity
Organization
Contact information
Practice address
6520 226TH PL SE STE 201, ISSAQUAH, WA 98027-8969
(425) 391-5504
(425) 391-3670
Mailing address
11711 NE 12TH ST STE 3A, BELLEVUE, WA 98005-2461
(425) 450-9474
(425) 452-0704
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
225100000X
Physical Therapist
Primary
—
WA
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039830
LABOR AND INDUSTRY
WA
Enumeration date
04/19/2007
Last updated
11/27/2020
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