Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 60168643 | WA |
NPI | 1477175016 |
---|---|
Provider Name | Alicia Nowak |
First Address | Bothell, WA 98021-8524 |
Second Address | Kirkland, WA 98034-3029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2020 |
Last Update Date | 16/05/2020 |