Basic Information
| Provider Information | |||||||||
| NPI: | 1417103284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEHY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10505 19TH AVE SE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982084280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252497788 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3726 BROADWAY | ||||||||
| Address2: | #104 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252524600 | ||||||||
| FaxNumber: | 4252524477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60144170 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.