Healthcare Provider Details

I. General information

NPI: 1104874577
Provider Name (Legal Business Name): NINA MARIE ALTMAN MED BSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA MARIE HATTON OR HENDERSON

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 BRIDGEPORT WAY W SUITE 203
LAKEWOOD WA
98499-8000
US

IV. Provider business mailing address

4040 ORCHARD ST W SUITE 100
FIRCREST WA
98466-6606
US

V. Phone/Fax

Practice location:
  • Phone: 253-582-8500
  • Fax: 253-582-8506
Mailing address:
  • Phone: 253-564-1560
  • Fax: 253-564-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00002421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: