=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306843933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIKA TIMKA DALKIN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 41ST AVE SW STE 100
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98116-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-932-8363
-----------------------------------------------------
Fax | 206-932-4973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16083 SW UPPER BOONES FERRY RD SUITE 300
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97224-7736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-219-8835
-----------------------------------------------------
Fax | 503-639-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2054
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT60058054
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------