Healthcare Provider Details

I. General information

NPI: 1710578257
Provider Name (Legal Business Name): AUDE PUYFOULHOUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 NE BEL RED RD STE 100
BELLEVUE WA
98005-2509
US

IV. Provider business mailing address

19408 82ND PL W
EDMONDS WA
98026-6207
US

V. Phone/Fax

Practice location:
  • Phone: 425-450-9801
  • Fax:
Mailing address:
  • Phone: 206-376-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP161037230
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: