MEDICARE: AMANDA THEISEN 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
1	225100000X	Physical Therapist	61388668	WA

General Provider Information

NPI Number	:	1861185324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA THEISEN DPT

Provider Business Mailing Address
First Line	:	1309 HARBOR AVE SW STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-1784
Country	:	US
Telephone Number	:	206-906-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 SW NEVADA ST UNIT A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2537
Country	:	US
Telephone Number	:	320-339-4030
Fax Number	:

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

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	04/15/2025

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Directions to “ AMANDA THEISEN DPT” Practice Location

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