Healthcare Provider Details

I. General information

NPI: 1013055003
Provider Name (Legal Business Name): ZANDRA J. RAEF ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZANDRA J. MILLS ATC

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7728 204TH ST. NE SUITE A
ARLINGTON WA
98223
US

IV. Provider business mailing address

8525 176TH PL NE
ARLINGTON WA
98223-4055
US

V. Phone/Fax

Practice location:
  • Phone: 360-403-8250
  • Fax: 360-403-0917
Mailing address:
  • Phone: 360-435-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: