Healthcare Provider Details

I. General information

NPI: 1750424370
Provider Name (Legal Business Name): ANTHONY HALBEISEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E JEFFERSON ST SUITE A-5
SEATTLE WA
98122-5698
US

IV. Provider business mailing address

1600 E JEFFERSON ST SUITE A-5
SEATTLE WA
98122-5698
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2404
  • Fax: 206-320-4747
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00007921
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: