Healthcare Provider Details

I. General information

NPI: 1700329745
Provider Name (Legal Business Name): EASTWEST MEDICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVENUE SUITE 1700
SEATTLE WA
98104-3549
US

IV. Provider business mailing address

901 BOREN AVENUE SUITE 1700
SEATTLE WA
98104-3549
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-7924
  • Fax: 206-508-9092
Mailing address:
  • Phone: 206-257-7924
  • Fax: 206-508-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP60238547
License Number StateWA

VIII. Authorized Official

Name: DR. LEE A ROBERTSON
Title or Position: PRESIDENT
Credential:
Phone: 206-257-7924