Basic Information
| Provider Information | |||||||||
| NPI: | 1295890168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHICK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4220 132ND ST SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579380 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 LILLY RD NE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604860640 | ||||||||
| FaxNumber: | 3604860641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00010314 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4488SC | 01 | WA | REGENCE BLUE SHIELD | OTHER | 710883456-98501-A008 | 01 | WA | TRICARE | OTHER | 7117907 | 01 | WA | AETNA | OTHER | 710883456-98503-A007 | 01 | WA | TRICARE | OTHER | 8471112 | 05 | WA | MEDICAID | 710883456-98502-A004 | 01 | WA | TRICARE | OTHER | 710883456-98512-A005 | 01 | WA | TRICARE | OTHER | 4848SC | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8483SC | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8943300 | 01 | WA | L&I CRIME VICTIMS | OTHER | 0216247 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 3348SC | 01 | WA | REGENCE BLUE SHIELD | OTHER |