Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00009027 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00009027 | WA |
NPI | 1326020926 |
---|---|
Provider Name | Lora J Clothier |
First Address | Seattle, WA 98116-3753 |
Second Address | Seattle, WA 98116-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 12/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0282806 | LABOR & INDUSTRIES (01) | WA |
1193SC | REGENCE BLUE SHIELD (01) | WA |
G8904843 | MEDICARE PTAN (01) | WA |