Healthcare Provider Details

I. General information

NPI: 1689492308
Provider Name (Legal Business Name): SEOKJAE CHOE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON STATE UNIVERSITY
PULLMAN WA
99164-0001
US

IV. Provider business mailing address

SMITH GYM 211A 1345 NE COLORADO STREET
PULLMAN WA
99164-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-249-6457
  • Fax:
Mailing address:
  • Phone: 402-249-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATHL.A1.70032388
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: