Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 293414 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 61102342 | WA |
NPI | 1023533874 |
---|---|
Provider Name | Travis Depew |
First Address | Bellevue, WA 98007-3120 |
Second Address | Bellevue, WA 98007-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2017 |
Last Update Date | 31/08/2021 |