Healthcare Provider Details

I. General information

NPI: 1730570383
Provider Name (Legal Business Name): PATTY BOETTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 168TH ST NE #A102
ARLINGTON WA
98223-8461
US

IV. Provider business mailing address

10505 19TH AVE SE SUITE B
EVERETT WA
98208-4280
US

V. Phone/Fax

Practice location:
  • Phone: 360-658-8100
  • Fax: 360-658-0508
Mailing address:
  • Phone: 408-570-0510
  • Fax: 408-945-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160031642
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: