Healthcare Provider Details

I. General information

NPI: 1598729642
Provider Name (Legal Business Name): MANDY M PRITCHARD MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MANDY M MOE MPT

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17650 140TH AVE SE #B-07
RENTON WA
98058-6814
US

IV. Provider business mailing address

PO BOX 731269
PUYALLUP WA
98373-0060
US

V. Phone/Fax

Practice location:
  • Phone: 425-430-0700
  • Fax: 425-430-0710
Mailing address:
  • Phone: 253-840-2313
  • Fax: 253-840-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009096
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: