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General NPI Number Information
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NPI Number | 1689496366
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Entity Type | Organization
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Legal Business Name | CONSCIOUS RESET PLLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5135 S BANGOR ST UNIT B
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City | SEATTLE
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State | WA
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Zip | 98178-2108
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Country | US
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Telephone | 833-777-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 UNIVERSITY WAY NE STE 104
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City | SEATTLE
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State | WA
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Zip | 98105-4424
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Country | US
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Telephone | 833-777-2500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOROTEYA J JACKSON
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Credential | DPT
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Telephone | 833-777-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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