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General NPI Number Information
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NPI Number | 1528514825
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Entity Type | Individual
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Provider Name | DESTINY MOREY
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 14110 NE 179TH STREET #73
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City | WOODINVILLE
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State | WA
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Zip | 98072-6899
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Country | US
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Telephone | 425-445-8317
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Fax |
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Provider Business Mailing Address
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Address Line | 14110 NE 179TH ST #73
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City | WOODINVILLE
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State | WA
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Zip | 98072-6899
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Country | US
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Telephone | 425-445-8317
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P160216273
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License Number State | WA
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