Healthcare Provider Details

I. General information

NPI: 1376897371
Provider Name (Legal Business Name): CARA SUZANNE FEDERSPIEL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 SE EVERETT MALL WAY STE 200
EVERETT WA
98208-3743
US

IV. Provider business mailing address

906 SE EVERETT MALL WAY STE 200
EVERETT WA
98208-3743
US

V. Phone/Fax

Practice location:
  • Phone: 425-353-5656
  • Fax: 425-513-2807
Mailing address:
  • Phone: 425-353-5656
  • Fax: 425-513-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00006699
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: