Provider Demographics
NPI:1316242282
Name:BACA, ANNA LESLIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LESLIE
Last Name:BACA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LESLIE
Other - Last Name:ENGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX #359827 325 9TH AVENUE
Mailing Address - Street 2:HARBORVIEW MEDICAL CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVENUE, BOX #359827
Practice Address - Street 2:HARBORVIEW MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-744-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033181225100000X
WA60317715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist