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LAKE FOREST PARK PHYSICAL THERAPY, PLLC

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Company Details

Legal Name: LAKE FOREST PARK PHYSICAL THERAPY, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: March 16th 2009
Date of Dissolution: July 1st 2013
Expiration date: 31 Mar 2013
UBI Number: 602 911 287
ZIP code: 98155
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 20011 BALLINGER WAY NE, STE C100, SHORELINE, WA, 98155, UNITED STATES

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Registered Agent Information

Name Role Address
LOREN JOHNSON Registered Agent 328 S STILLAGUMISH AVE, ARLINGTON, WA, 98223, UNITED STATES

Key Officers & Management

Name Role
LEON JENSON Governing Person
LOREN JOHNSON Governing Person
JILL JOHNSON Governing Person

National Provider Identifier

NPI Number:
1588806848

Authorized Person:

Name:
MRS. ROBYN NAMIKO WHITEHEAD
Role:
EXECUTIVE DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2063676319
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