Healthcare Provider Details

I. General information

NPI: 1346357258
Provider Name (Legal Business Name): PAIGE A. MCNERTHNEY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE SUITE 115
BOTHELL WA
98021-4412
US

IV. Provider business mailing address

2857 NW 73RD ST
SEATTLE WA
98117-6254
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-5444
  • Fax: 425-485-5588
Mailing address:
  • Phone: 425-485-5444
  • Fax: 425-485-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00009083
License Number StateWA

VII. Legacy identifiers

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

# 1
Identifier1346357258
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier8364051
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: