Basic Information
| Provider Information | |||||||||
| NPI: | 1336493576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEEHAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | JEANNE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4320 196TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259670051 | ||||||||
| FaxNumber: | 4259670053 | ||||||||
| Practice Location | |||||||||
| Address1: | 4320 196TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259670051 | ||||||||
| FaxNumber: | 4259670053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | P1 60033358 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.