Healthcare Provider Details

I. General information

NPI: 1750155230
Provider Name (Legal Business Name): ELISABETH PETRAS DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

IV. Provider business mailing address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-7710
  • Fax: 425-483-6059
Mailing address:
  • Phone: 425-486-7710
  • Fax: 425-483-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61443326
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: