MEDICARE: VIRGINIA D MENTING PT

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	PT00007951	WA

General Provider Information

NPI Number	:	1316900970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA D MENTING PT

Provider Business Mailing Address
First Line	:	1560 140TH AVE NE
Second Line	:	SUITE 100
City	:	BELLEVUE
State	:	WA
Zip	:	98005-4571
Country	:	US
Telephone Number	:	425-746-2475
Fax Number	:	425-746-2471

Provider Business Practice Location Address
First Line	:	22500 SE 64TH PL
Second Line	:	BUILDING G, SUITE 115
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-441-6075
Fax Number	:	425-746-2471

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	10/06/2016

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