Provider Demographics
NPI:1548460090
Name:NORTHSHORE PHYSICAL THERAPY
Entity type:Organization
Organization Name:NORTHSHORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-487-3142
Mailing Address - Street 1:18107 BOTHELL WAY NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1900
Mailing Address - Country:US
Mailing Address - Phone:425-487-3142
Mailing Address - Fax:
Practice Address - Street 1:18107 BOTHELL WAY NE
Practice Address - Street 2:SUITE 106
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1900
Practice Address - Country:US
Practice Address - Phone:425-487-3142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB10944OtherGROUP NUMBER