Basic Information
| Provider Information | |||||||||
| NPI: | 1538143938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | LAUREL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BS, MS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUSTAFSON | ||||||||
| OtherFirstName: | JASMINE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8750 GREENWOOD AVE N, SUITE S-1 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067825789 | ||||||||
| FaxNumber: | 2067825794 | ||||||||
| Practice Location | |||||||||
| Address1: | 8750 GREENWOOD AVE N, SUITE S-1 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067825789 | ||||||||
| FaxNumber: | 2067825794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009254 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 4663 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8372823 | 05 | WA | MEDICAID |