Healthcare Provider Details

I. General information

NPI: 1386217214
Provider Name (Legal Business Name): ADRIENNE RODDY-BALE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13242 AURORA AVE N STE 103
SEATTLE WA
98133-7026
US

IV. Provider business mailing address

8358 13TH AVE NW APT 5
SEATTLE WA
98117-4202
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number61161829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: