Healthcare Provider Details

I. General information

NPI: 1952073447
Provider Name (Legal Business Name): MARINA LILY CHEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 25TH AVE NE STE 201
SEATTLE WA
98105-4152
US

IV. Provider business mailing address

4455 INTERLAKE AVE N UNIT 431
SEATTLE WA
98103-7591
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-6702
  • Fax: 206-524-6703
Mailing address:
  • Phone: 507-573-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT61147525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: