MEDICARE: MS. RANDI MARIT SUNDBY MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00006948	WA

General Provider Information

NPI Number	:	1043386493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RANDI MARIT SUNDBY MSPT

Provider Business Mailing Address
First Line	:	9518 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2234
Country	:	US
Telephone Number	:	206-524-1058
Fax Number	:	206-524-1059

Provider Business Practice Location Address
First Line	:	9518 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2234
Country	:	US
Telephone Number	:	206-524-1058
Fax Number	:	206-524-1059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/22/2017

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