Provider Demographics
NPI:1962694091
Name:SOINE, SUZANNE KIRSTEN (DPT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KIRSTEN
Last Name:SOINE
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 1:100 NE NORTHLAKE WAY
Mailing Address - Street 2:STE 200B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6871
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1188 106TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8612
Practice Address - Country:US
Practice Address - Phone:425-455-2630
Practice Address - Fax:425-451-4390
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8517690Medicaid
WA8517690Medicaid