Provider Demographics
NPI:1154404531
Name:WILLIAM J CARRIVEAU
Entity type:Organization
Organization Name:WILLIAM J CARRIVEAU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CARRIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-367-6744
Mailing Address - Street 1:10564 5TH AVE NE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-367-6477
Mailing Address - Fax:206-367-7748
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-367-6477
Practice Address - Fax:206-367-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0068095OtherLABOR & INDUSTRIES
WA7038490Medicaid
WA8805391Medicare ID - Type Unspecified