Provider Demographics
NPI:1174640759
Name:A.I.M. PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:A.I.M. PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-216-3600
Mailing Address - Street 1:415 ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1321
Mailing Address - Country:US
Mailing Address - Phone:253-216-3600
Mailing Address - Fax:253-862-2675
Practice Address - Street 1:415 ALDER AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1321
Practice Address - Country:US
Practice Address - Phone:253-216-3600
Practice Address - Fax:253-862-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005418225100000X
WAPT5418261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA171896OtherSTATE WORKERS COMP.
NDGAB38573OtherPTAN MEDICARE GROUP
GAB38573OtherPTAN MEDICARE GROUP
GAB38574OtherMEDICARE PTAN INDIVIDUAL
P00061737OtherMEDICARE RAILROAD
WA101837600OtherUS DEPT OF LABOR PROVIDER
WA1093897613OtherNPI INDIVIDUAL
WA7126303Medicaid
WAEG4516OtherBLUE SHIELD PROVIDER NO.
WA1174640759OtherGROUP NPI AIM
WA7126303Medicaid