Healthcare Provider Details

I. General information

NPI: 1548378094
Provider Name (Legal Business Name): RAANDI WIEBE MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N 205TH ST
SHORELINE WA
98133-3214
US

IV. Provider business mailing address

3121 27TH PL W #407
SEATTLE WA
98199
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-2220
  • Fax: 206-546-2228
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberWA5185
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: