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General NPI Number Information
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NPI Number | 1134306111
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Entity Type | Organization
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Legal Business Name | EASTSIDE REHABILITATION MEDICINE PS
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 02/17/2008
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Provider Practice Location Address
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Address Line | 12303 NE 130TH LANE, SUITE 220 EVERGREEN HOSPITAL PROFESSIONAL CENTER
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-899-6060
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Fax | 425-899-6078
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Provider Business Mailing Address
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Address Line | 1128 NE KATSURA ST
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City | ISSAQUAH
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State | WA
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Zip | 98029-6919
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Country | US
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Telephone | 425-392-8513
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Fax | 425-392-8521
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Authorized Official
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Title or Position | OWNER
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Name | DR. JILL ANNETTE WILLIAMS
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Credential | MEDICAL DOCTOR
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Telephone | 425-392-8513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD00041527
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License Number State | WA
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