Healthcare Provider Details

I. General information

NPI: 1194577163
Provider Name (Legal Business Name): SWARDHU RAUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19119 N CREEK PKWY STE 107
BOTHELL WA
98011-8023
US

IV. Provider business mailing address

12 E 46TH ST RM 501
NEW YORK NY
10017-2418
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-8800
  • Fax: 425-486-8848
Mailing address:
  • Phone: 917-837-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61686129
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050669-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: