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General NPI Number Information
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NPI Number | 1275929317
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Entity Type | Individual
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Provider Name | BRIDGET LAVAVESHKUL DPT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 7454 NEWCASTLE GOLF CLUB RD
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City | NEWCASTLE
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State | WA
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Zip | 98059-9176
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Country | US
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Telephone | 425-543-1508
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Fax |
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Provider Business Mailing Address
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Address Line | 610 GALER ST APT. 125
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City | SEATTLE
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State | WA
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Zip | 98109-3380
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Country | US
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Telephone | 785-760-4146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60349535
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License Number State | WA
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