Provider Demographics
NPI:1194707216
Name:PUGET ORTHOPEDIC REHABILITATION PC
Entity type:Organization
Organization Name:PUGET ORTHOPEDIC REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:BRENDA
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-348-1259
Mailing Address - Street 1:12811 8TH AVE W
Mailing Address - Street 2:A-205
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6335
Mailing Address - Country:US
Mailing Address - Phone:425-348-1259
Mailing Address - Fax:425-348-3071
Practice Address - Street 1:12811 8TH AVE W
Practice Address - Street 2:A-205
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6335
Practice Address - Country:US
Practice Address - Phone:425-348-1259
Practice Address - Fax:425-348-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29018GMedicare PIN