Healthcare Provider Details

I. General information

NPI: 1154466043
Provider Name (Legal Business Name): PAUL DE BEIJL PT, L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY STE 900
SEATTLE WA
98101-1840
US

IV. Provider business mailing address

720 OLIVE WAY STE 900
SEATTLE WA
98101-1840
US

V. Phone/Fax

Practice location:
  • Phone: 206-623-2220
  • Fax: 206-623-2228
Mailing address:
  • Phone: 206-623-2220
  • Fax: 206-623-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002074
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: