| NPI | 1134667306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KRISTINE RICHARDSON Manager 425-658-0658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: WA 604061445) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA 604-061-445) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: WA 604-061-445) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-07-12 |