NPIMap

Ann Avila

Individual provider Active NPI Physical Therapy Assistant · Federal Way, WA

NPI 1114207404 · NPPES record last updated Aug 18, 2011

Key facts

NPI
1114207404
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
P160031632 (WA)
Practice address
1010 S 336TH St
Suite 210
Federal Way, WA 98003-6385
Phone
(866) 835-8091
NPI assigned
Aug 18, 2011
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
P160031632WAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SHC Services Inc. Past Accepting new patients
Supplemental Healthcare Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X P160031632 WA Yes

Addresses

Primary practice location

1010 S 336TH St
Suite 210
Federal Way, WA 98003-6385

Mailing address

1010 S 336TH St
Suite 210
Federal Way, WA 98003-6385

Other providers in Federal Way, WA

All providers in Federal Way, WA · Physical Therapy Assistant in Washington

Sources for this page

Verify at the official NPI Registry.