MEDICARE: SUSAN DUMELIN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT00009470	OTHER	WA	LICENSE #

General Provider Information

NPI Number	:	1568579928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DUMELIN

Provider Business Mailing Address
First Line	:	19217 36TH AVE W STE 102
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5751
Country	:	US
Telephone Number	:	425-670-9991
Fax Number	:	425-670-9995

Provider Business Practice Location Address
First Line	:	19217 36TH AVE W STE 102
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5751
Country	:	US
Telephone Number	:	425-670-9991
Fax Number	:	425-670-9995

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/01/2015

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Directions to “ SUSAN DUMELIN ” Practice Location

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