Healthcare Provider Details

I. General information

NPI: 1710275003
Provider Name (Legal Business Name): ZACHARY P BAULING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 1ST AVE W
SEATTLE WA
98119-4018
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE. 300
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 206-352-0105
  • Fax: 206-352-0106
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT60230931
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: