Healthcare Provider Details

I. General information

NPI: 1053235903
Provider Name (Legal Business Name): WILLIAM NOGUEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NE 8TH ST STE E6
BELLEVUE WA
98008-4087
US

IV. Provider business mailing address

2712 NE 9TH ST
RENTON WA
98056-3033
US

V. Phone/Fax

Practice location:
  • Phone: 425-214-7679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.P1.70131212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: