Provider Demographics
NPI:1902689524
Name:ALTIZER, AMBER MARIE (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 168TH ST NE STE A102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8462
Mailing Address - Country:US
Mailing Address - Phone:360-658-8100
Mailing Address - Fax:
Practice Address - Street 1:3710 168TH ST NE STE A102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8462
Practice Address - Country:US
Practice Address - Phone:360-658-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61141041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant