Healthcare Provider Details

I. General information

NPI: 1477803245
Provider Name (Legal Business Name): CHRISTINE HARENBERG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 N VISSCHER ST
TACOMA WA
98407-1916
US

IV. Provider business mailing address

4330 N VISSCHER ST
TACOMA WA
98407-1916
US

V. Phone/Fax

Practice location:
  • Phone: 253-571-6907
  • Fax: 253-571-6922
Mailing address:
  • Phone: 253-571-6907
  • Fax: 253-571-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00004023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: