Healthcare Provider Details

I. General information

NPI: 1164998548
Provider Name (Legal Business Name): EXPERIENCE MOMENTUM, INC - FREMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 35TH ST
SEATTLE WA
98103-8906
US

IV. Provider business mailing address

4030 ALDERWOOD MALL BLVD
LYNNWOOD WA
98036-6763
US

V. Phone/Fax

Practice location:
  • Phone: 206-309-3966
  • Fax: 425-776-0813
Mailing address:
  • Phone: 425-776-0803
  • Fax: 425-776-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: RHODA CHAVEZ-NOWLAN
Title or Position: BILLING MANAGER, FINANCE
Credential:
Phone: 425-776-0803