Healthcare Provider Details

I. General information

NPI: 1235896630
Provider Name (Legal Business Name): PROLIANCE SURGEONS, INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 220TH ST SW STE 200
MOUNTLAKE TERRACE WA
98043-2187
US

IV. Provider business mailing address

7320 216TH ST SW STE 320
EDMONDS WA
98026-8006
US

V. Phone/Fax

Practice location:
  • Phone: 425-673-3916
  • Fax: 425-673-3926
Mailing address:
  • Phone: 425-673-3916
  • Fax: 425-673-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CORI M. PLEASANT
Title or Position: MGR. PROVIDER RELATIONS/ENROLLMENT
Credential:
Phone: 206-838-2585