Provider Demographics
NPI:1285778332
Name:MARK, CHRISTINE CHAN (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CHAN
Last Name:MARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 - 121ST AVE. S.E.
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2827
Mailing Address - Country:US
Mailing Address - Phone:425-614-0605
Mailing Address - Fax:
Practice Address - Street 1:18107 BOTHELL WAY NE
Practice Address - Street 2:SUITE 106
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1900
Practice Address - Country:US
Practice Address - Phone:425-487-3142
Practice Address - Fax:425-487-8785
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB10946Medicare ID - Type UnspecifiedMEDICARE