Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 00002605 | WA |
NPI | 1003150558 |
---|---|
Provider Name | Jane Ellen Baumgartner |
First Address | Kenmore, WA 98028-3372 |
Second Address | Bothell, WA 98021-8972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2012 |
Last Update Date | 22/11/2012 |