Provider Demographics
NPI:1306628847
Name:WEST SEATTLE PELVIC HEALTH & PT
Entity type:Organization
Organization Name:WEST SEATTLE PELVIC HEALTH & PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-228-4023
Mailing Address - Street 1:4417 46TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4127
Mailing Address - Country:US
Mailing Address - Phone:206-228-4023
Mailing Address - Fax:
Practice Address - Street 1:3270 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3305
Practice Address - Country:US
Practice Address - Phone:206-228-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy