Healthcare Provider Details

I. General information

NPI: 1861945909
Provider Name (Legal Business Name): SUZANNE RUTH NELSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 TERRY AVE
SEATTLE WA
98101-2747
US

IV. Provider business mailing address

11026 NE 144TH ST
KIRKLAND WA
98034-4411
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-2661
  • Fax:
Mailing address:
  • Phone: 206-747-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60389339
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: