Healthcare Provider Details

I. General information

NPI: 1104041417
Provider Name (Legal Business Name): JUDI TRAINOR PT, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH VANDER MOLEN

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 40TH AVE W SUITE 330
LYNNWOOD WA
98036-4612
US

IV. Provider business mailing address

514 N 75TH ST
SEATTLE WA
98103-4746
US

V. Phone/Fax

Practice location:
  • Phone: 425-670-9987
  • Fax: 425-744-7233
Mailing address:
  • Phone: 206-781-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPT00002657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: