Healthcare Provider Details

I. General information

NPI: 1912680513
Provider Name (Legal Business Name): MADISON URTUSUASTEGUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 2ND AVE STE 100
SEATTLE WA
98121-1464
US

IV. Provider business mailing address

2505 2ND AVE STE 100
SEATTLE WA
98121-1464
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-4020
  • Fax:
Mailing address:
  • Phone: 206-624-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP161384316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: