Healthcare Provider Details

I. General information

NPI: 1790996718
Provider Name (Legal Business Name): CARLA CORRADO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 UNIVERSITY WAY NE
SEATTLE WA
98105-2619
US

IV. Provider business mailing address

129 NW 77TH ST
SEATTLE WA
98117-3018
US

V. Phone/Fax

Practice location:
  • Phone: 206-729-1405
  • Fax: 206-324-0543
Mailing address:
  • Phone: 206-550-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00004096
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: