Basic Information
Provider Information | |||||||||
NPI: | 1154619757 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROMBOUGH | ||||||||
FirstName: | ALEXANDRA | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT, CSCS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4040 ORCHARD ST W | ||||||||
Address2: | STE. 100 | ||||||||
City: | FIRCREST | ||||||||
State: | WA | ||||||||
PostalCode: | 984666606 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535641560 | ||||||||
FaxNumber: | 2535644449 | ||||||||
Practice Location | |||||||||
Address1: | 14800 STARFIRE WAY | ||||||||
Address2: |   | ||||||||
City: | TUKWILA | ||||||||
State: | WA | ||||||||
PostalCode: | 981888502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2062677811 | ||||||||
FaxNumber: | 2062677813 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/16/2011 | ||||||||
LastUpdateDate: | 11/12/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60314131 | WA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.