Healthcare Provider Details

I. General information

NPI: 1952707911
Provider Name (Legal Business Name): JONATHAN DYK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 41ST AVE SW
SEATTLE WA
98116-4220
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE 300
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-8363
  • Fax: 206-932-4973
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60483817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: