Provider Demographics
NPI:1053545319
Name:PAIN SCIENCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PAIN SCIENCE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:ORIT
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-327-9880
Mailing Address - Street 1:15511 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2531
Mailing Address - Country:US
Mailing Address - Phone:206-327-9880
Mailing Address - Fax:206-327-9977
Practice Address - Street 1:15511 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2531
Practice Address - Country:US
Practice Address - Phone:206-327-9880
Practice Address - Fax:206-327-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010537225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty