Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT00005297 | WA |
NPI | 1508074535 |
---|---|
Provider Name | Laurel I Beck |
First Address | Seattle, WA 98101-2756 |
Second Address | Seattle, WA 98101-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 11/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0039585 | LABOR AND INDUSTRIES # (01) | WA |
8337560 | (05) | WA |
CA9446 | BLUE SHIELD # (01) | WA |
Q13470 | (02) | |
US1048049 | AETNA SPECIALIST PIN (01) | WA |