Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT00000681 | WA |
NPI | 1164754818 |
---|---|
Provider Name | Dr. Mary Delap Sandstrom |
First Address | Seattle, WA 98112 |
Second Address | Seattle, WA 98112-3511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2010 |
Last Update Date | 05/02/2010 |