Provider Demographics
NPI:1104874577
Name:ALTMAN, NINA MARIE (MED BSPT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MED BSPT
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:MARIE
Other - Last Name:HATTON OR HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-8500
Practice Address - Fax:253-582-8506
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8363830Medicaid
WA8852389Medicare ID - Type Unspecified
WA8852390Medicare ID - Type Unspecified