Basic Information
| Provider Information | |||||||||
| NPI: | 1407803158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOW MCGAVIN | ||||||||
| FirstName: | TERI | ||||||||
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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: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 10207 19TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982084257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253373166 | ||||||||
| FaxNumber: | 4253384596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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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 | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3258LO | 01 | WA | REGENCE BLUE SHIELD | OTHER | 650021416 | 01 | WA | RAILROAD MEDICARE | OTHER | 6565LO | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8928438 | 01 | WA | L&I CRIME VICTIMS | OTHER | 0273747 | 01 | WA | DEPT OF L&I | OTHER | 2253LO | 01 | WA | REGENCE BLUE SHIELD | OTHER | 0042LO | 01 | WA | REGENCE | OTHER | 0273752 | 01 | WA | DEPT OF L&I | OTHER | 8336398 | 05 | WA | MEDICAID | 5470289 | 01 | WA | AETNA | OTHER | 911745305-98208-A005 | 01 | WA | TRICARE | OTHER | 911745305-98208-B007 | 01 | WA | TRICARE | OTHER | 0150733 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 5782LO | 01 | WA | REGENCE | OTHER |