Healthcare Provider Details

I. General information

NPI: 1457465049
Provider Name (Legal Business Name): VIMLA B KATARA MADISON PHYSICAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18506 NW MONTREUX DR
ISSAQUAH WA
98027-7871
US

IV. Provider business mailing address

18506 NW MONTREUX DR
ISSAQUAH WA
98027-7871
US

V. Phone/Fax

Practice location:
  • Phone: 425-401-8182
  • Fax: 425-401-8182
Mailing address:
  • Phone: 425-401-8182
  • Fax: 425-401-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00001092
License Number StateWA

VIII. Authorized Official

Name: MS. VIMLA B KATARA
Title or Position: SOLE PROPRIETOR/OWNER
Credential: P.T.
Phone: 425-401-8182