MEDICARE: DR. SOUNDUS MACHTLEY PT, DPT, OCS, MTC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT00010361	WA
2	225100000X	Physical Therapist	PT10361	WA

General Provider Information

NPI Number	:	1326184409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOUNDUS MACHTLEY PT, DPT, OCS, MTC

Provider Business Mailing Address
First Line	:	2319 N 45TH ST
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98103-6982
Country	:	US
Telephone Number	:	206-910-9590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 N 45TH ST
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98103-6982
Country	:	US
Telephone Number	:	206-910-9590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	05/11/2015

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