Healthcare Provider Details

I. General information

NPI: 1720134828
Provider Name (Legal Business Name): KATIE BETTINA GRUBB P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN AVE S
NORTH BEND WA
98045-8215
US

IV. Provider business mailing address

11711 NE 12TH ST STE. 3A
BELLEVUE WA
98005-2461
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-1156
  • Fax: 425-888-6167
Mailing address:
  • Phone: 425-214-0020
  • Fax: 425-452-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 00008246
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: