=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972915601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACLYN DURANT HAHN PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 07/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 FREMONT AVE N SUITE 216
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-548-1522
-----------------------------------------------------
Fax | 425-746-2471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1560 140TH AVE NE SUITE 100
-----------------------------------------------------
City | BELLVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-746-2475
-----------------------------------------------------
Fax | 425-746-2471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT60456133
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------