Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT60661260 | WA |
NPI | 1013460856 |
---|---|
Provider Name | Samantha Van Gorder |
First Address | Bellevue, WA 98005-4571 |
Second Address | Bellevue, WA 98005-4571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 28/07/2016 |