Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00006348 | WA |
N | 2251N0400X | Physical Therapist - Neurology | PT00006348 | WA |
NPI | 1336250109 |
---|---|
Provider Name | Amy M. Icarangal |
First Address | Seattle, WA 98104-2420 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/07/2007 |