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General NPI Number Information
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NPI Number | 1629636055
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Entity Type | Organization
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Legal Business Name | PUGET SOUND WORK INJURY CLINIC, LLC
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 812 CHERRY CT
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-509-8160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2017
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City | BREMERTON
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State | WA
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Zip | 98310-0231
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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 | PARTNER
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Name | KATHY YVONNE BRADFORD
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Credential | APRN
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Telephone | 360-770-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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