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General NPI Number Information
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NPI Number | 1477068641
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED PAIN & MOVEMENT THERAPY
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 875 140TH AVE NE STE 103
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-531-9886
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Fax | 253-345-5129
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Provider Business Mailing Address
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Address Line | 875 140TH AVE NE STE 103
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City | BELLEVUE
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State | WA
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Zip | 98005-3400
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Country | US
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Telephone | 425-531-9886
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Fax | 253-345-5129
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH A ROSEVEAR
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Credential | MS, OTR/L
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Telephone | 425-531-9886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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