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NPI Code Detail

MEDICARE: ELENA SUZANNE WACK DPT

MEDICARE: ELENA SUZANNE WACK DPT
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
1225100000XPhysical TherapistPT60421494WA

General Provider Information

NPI Number : 1104241728
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELENA SUZANNE WACK DPT
Provider Business Mailing Address
First Line : 9315 GRAVELLY LAKE DR SW
Second Line : SUITE 306
City : LAKEWOOD
State : WA
Zip : 98499-1574
Country : US
Telephone Number : 253-581-5200
Fax Number : 253-581-5203
Provider Business Practice Location Address
First Line : 9514 GRAVELLY LAKE DR SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-1514
Country : US
Telephone Number : 253-983-9395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2014
Last Update Date : 02/19/2014

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Directions to “ ELENA SUZANNE WACK DPT” Practice Location

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