MEDICARE: THERESE LAW MD PS

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	174400000X	Specialist	MD00018491	WA

General Provider Information

NPI Number	:	1629309273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESE LAW MD PS

Provider Business Mailing Address
First Line	:	320 NE 97TH ST STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2042
Country	:	US
Telephone Number	:	206-323-8113
Fax Number	:	206-323-1457

Provider Business Practice Location Address
First Line	:	320 NE 97TH ST STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2042
Country	:	US
Telephone Number	:	206-323-8113
Fax Number	:	206-323-1457

Authorized Official
Title or Position	:	MANAGER
Name	:	BYRON RICE
Credential	:
Telephone Number	:	425-825-8674

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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