Provider Demographics
NPI:1013175744
Name:ULTIMATE PERFORMANCE REHABILITATION LLC
Entity type:Organization
Organization Name:ULTIMATE PERFORMANCE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILYARD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:360-697-3003
Mailing Address - Street 1:19351 8TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8710
Mailing Address - Country:US
Mailing Address - Phone:360-697-3003
Mailing Address - Fax:360-697-3026
Practice Address - Street 1:19351 8TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8710
Practice Address - Country:US
Practice Address - Phone:360-697-3003
Practice Address - Fax:360-697-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002325261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation