Healthcare Provider Details

I. General information

NPI: 1184442360
Provider Name (Legal Business Name): ELLA POMPLUN DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 INTERLAKE AVE N STE 8
SEATTLE WA
98103-6700
US

IV. Provider business mailing address

4219 S OTHELLO ST APT 753
SEATTLE WA
98118-3891
US

V. Phone/Fax

Practice location:
  • Phone: 206-905-8575
  • Fax:
Mailing address:
  • Phone: 262-323-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61594848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: