Provider Demographics
NPI:1316481450
Name:ZACHWIEJA, JASMIN (ATC)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:ZACHWIEJA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13741 15TH AVE NE APT C11
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3125
Mailing Address - Country:US
Mailing Address - Phone:805-558-6356
Mailing Address - Fax:
Practice Address - Street 1:13741 15TH AVE NE APT C11
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3125
Practice Address - Country:US
Practice Address - Phone:805-558-6356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAATHL.A1.60787717OtherWA STATE LICENSING
ORAT-AT-10184310OtherOREGON HEALTH LICENSING