Basic Information
| Provider Information | |||||||||
| NPI: | 1528294626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | EILEE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MSPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | THOMPSON | ||||||||
| OtherFirstName: | EILEE | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | MSPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10505 19TH AVE SE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982084280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085700510 | ||||||||
| FaxNumber: | 4089454018 | ||||||||
| Practice Location | |||||||||
| Address1: | 3726 BROADWAY | ||||||||
| Address2: | STE 104 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252524600 | ||||||||
| FaxNumber: | 4252524477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 10/22/2012 | ||||||||
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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 | 225100000X | PT00008513 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | G8896583 | 01 | WA | MEDICARE | OTHER |