=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962318766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN NGUYENLE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2026
-----------------------------------------------------
Last Update Date | 08/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 S PARK ST
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99006-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-276-8811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 707 S PARK ST
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99006-7025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------