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General NPI Number Information
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NPI Number | 1538594833
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Entity Type | Individual
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Provider Name | ANIKA TIDEMAN D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 07/02/2017
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Provider Practice Location Address
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Address Line | 3200 W MCGRAW ST
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City | SEATTLE
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State | WA
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Zip | 98199-3208
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Country | US
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Telephone | 206-281-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 W DRAVUS ST APT 406
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City | SEATTLE
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State | WA
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Zip | 98199-4611
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 9437
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License Number State | MN
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