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NPI Code Detail

MEDICARE: MALLORY OLMSTEAD PTA

MEDICARE: MALLORY OLMSTEAD PTA
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
1225200000XPhysical Therapy AssistantP1 60639331WA

General Provider Information

NPI Number : 1881147163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY OLMSTEAD PTA
Provider Business Mailing Address
First Line : 1218 3RD AVE STE 104
Second Line :
City : SEATTLE
State : WA
Zip : 98101-3008
Country : US
Telephone Number : 206-447-2220
Fax Number : 206-447-2228
Provider Business Practice Location Address
First Line : 1218 3RD AVE STE 104
Second Line :
City : SEATTLE
State : WA
Zip : 98101-3008
Country : US
Telephone Number : 206-447-2220
Fax Number : 206-447-2228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2016
Last Update Date : 08/03/2016

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Directions to “ MALLORY OLMSTEAD PTA” Practice Location

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