Healthcare Provider Details

I. General information

NPI: 1558640748
Provider Name (Legal Business Name): ASHLEY DAWN DARNELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY DAWN GUSTAFSON DPT

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 W UNION AVE STE 101
TACOMA WA
98405-2062
US

IV. Provider business mailing address

915 118TH AVE SE STE 110
BELLEVUE WA
98005-3875
US

V. Phone/Fax

Practice location:
  • Phone: 532-512-5572
  • Fax: 253-393-9187
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60229097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: