Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 60541947 | WA |
NPI | 1003459165 |
---|---|
Provider Name | Denis Rotari |
First Address | Wilsonville, OR 97070-9697 |
Second Address | Seattle, WA 98117-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 14/11/2019 |