| Organization Name: | SOURCE PHYSICAL THERAPY LLC |
| NPI Number: | 1962593871 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANA CARNAHAN (OWNER) |
| Mailing Address: | 6659 Kimball Dr Suite A101 Gig Harbor |
| State: | WA US |
| Postal Code: | 983355137 |
| Phone Number: | 2538574870 |
| Fax Number: | 2538574876 |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 09/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 602296233 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |