Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT00005995 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00005995 | WA |
NPI | 1447232970 |
---|---|
Provider Name | Candace S Ito |
First Address | Seattle, WA 98125-6111 |
Second Address | Seattle, WA 98125-6111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0148998 | LABOR AND INDUSTRIES (01) | WA |
1910872 | FIRST HEALTH (01) | WA |
57231T | REGENCE BLUE SHIELD (01) | WA |