Organization
GREENLAKE SPORTS PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BART D SIMONS PT (OWNERPRESIDENT)
(206) 524-5115
Entity
Organization
Contact information
Practice address
7209 WOODLAWN AVE NE, SEATTLE, WA 98115-5335
(206) 524-5115
(206) 524-2456
Mailing address
7209 WOODLAWN AVE NE, SEATTLE, WA 98115-5335
(206) 524-5115
(206) 524-2456
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00004077
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265462857
NPI
WA
Enumeration date
03/15/2007
Last updated
08/22/2020
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