=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265961957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLFUEL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2017
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4839 S BRANDON ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-2359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-448-2567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4839 S BRANDON ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-2359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-448-2567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | NICOLE BULOW
-----------------------------------------------------
Credential | PT, DPT, CFMT, ATC
-----------------------------------------------------
Telephone | 425-448-2567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------