Provider Demographics
NPI:1982994885
Name:ROLEY, SUSAN (DPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROLEY
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 1:6161 NE 175TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4800
Mailing Address - Country:US
Mailing Address - Phone:425-482-2453
Mailing Address - Fax:425-482-2452
Practice Address - Street 1:6161 NE 175TH ST STE 203
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4800
Practice Address - Country:US
Practice Address - Phone:425-482-2453
Practice Address - Fax:425-482-2452
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60130851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist