| Organization Name: | PEDERSEN OUTPATIENT PHYSICAL THERAPY |
| NPI Number: | 1104040856 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GEORGE PEDERSEN (THERAPIST) |
| Mailing Address: | 1110 Stevenson Ave Suite 100 Enumclaw |
| State: | WA US |
| Postal Code: | 980222647 |
| Phone Number: | 3608257411 |
| Fax Number: | 3608257434 |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 03/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |