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General NPI Number Information
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NPI Number | 1730366881
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTH CARE
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 556 ANACORTES CT NE UNIT 102
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City | RENTON
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State | WA
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Zip | 98059-5768
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Country | US
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Telephone | 206-310-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 556 ANACORTES CT NE UNIT 102
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City | RENTON
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State | WA
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Zip | 98059-5768
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Country | US
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Telephone | 206-310-5474
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Fax |
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Authorized Official
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Title or Position | PTA
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Name | MS. NANCY ELIZABETH DANNEMILLER
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Credential | PTA
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Telephone | 206-310-5474
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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 |
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License Number State | WA
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