Provider Demographics
NPI:1316265804
Name:MEDIGOVIK, STANISLAVA (DPT)
Entity type:Individual
Prefix:
First Name:STANISLAVA
Middle Name:
Last Name:MEDIGOVIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2152
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:6985 COAL CREEK PKWY SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3136
Practice Address - Country:US
Practice Address - Phone:425-378-0500
Practice Address - Fax:425-378-8168
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60571720225100000X, 225100000X
PAPTO20512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
306208OtherUNISON
2502494OtherPA BLUE SHIELD
PA1316265804OtherBRAVO
PA102455719-0001Medicaid
PA30072582OtherKEYSTONE MERCY
PA3779584000OtherIBC
DE1316265804Medicaid
PA0899VLZAMedicare PIN
DE1316265804Medicaid