Healthcare Provider Details

I. General information

NPI: 1497896575
Provider Name (Legal Business Name): NANCY C FOGEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 AVENUE D
SNOHOMISH WA
98290-2744
US

IV. Provider business mailing address

18323 BOTHELL EVERETT HWY SUITE 220
BOTHELL WA
98012-5246
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-1020
  • Fax: 360-563-9040
Mailing address:
  • Phone: 425-806-5721
  • Fax: 425-806-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007524
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: