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General NPI Number Information
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NPI Number | 1932692928
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Entity Type | Individual
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Provider Name | WESLEY AARON HARDGROVE MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 3101 NORTHUP WAY STE 201
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City | BELLEVUE
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State | WA
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Zip | 98004-1449
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Country | US
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Telephone | 425-455-3600
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Fax | 425-455-3920
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Provider Business Mailing Address
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Address Line | 510 8TH AVE NE STE 320
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City | ISSAQUAH
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State | WA
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Zip | 98029-5436
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Country | US
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Telephone | 425-507-0733
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Fax | 425-283-5551
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD61442573
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License Number State | WA
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