Healthcare Provider Details

I. General information

NPI: 1649756883
Provider Name (Legal Business Name): AMY ELIZABETH HARDIMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH VOGT

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S
RENTON WA
98055-5773
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4006
  • Fax:
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160038510
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: