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NPI Code Detail

MEDICARE: THE ATHLETE EXPERIENCE

MEDICARE: THE ATHLETE EXPERIENCE
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
1261QR0400XRehabilitation Clinic/CenterOT4189WA

General Provider Information

NPI Number : 1871975110
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE ATHLETE EXPERIENCE
Provider Business Mailing Address
First Line : 2818 E MADISON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98112-4841
Country : US
Telephone Number : 206-641-7733
Fax Number : 206-641-3272
Provider Business Practice Location Address
First Line : 2818 E MADISON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98112-4841
Country : US
Telephone Number : 206-641-7733
Fax Number : 206-641-3272
Authorized Official
Title or Position : OWNER
Name : AARON SHAW
Credential : OTR/L, CHT, CSCS
Telephone Number : 206-914-9666
Provider Enumeration Date : 06/23/2015
Last Update Date : 06/23/2015

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Directions to “THE ATHLETE EXPERIENCE ” Practice Location

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