Healthcare Provider Details

I. General information

NPI: 1295942894
Provider Name (Legal Business Name): SUELLEN OBRIEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 S 308TH ST
FEDERAL WAY WA
98003-4706
US

IV. Provider business mailing address

16707 SE 235TH ST
KENT WA
98042-4719
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-2273
  • Fax:
Mailing address:
  • Phone: 253-639-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00002706
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: