Basic Information
| Provider Information | |||||||||
| NPI: | 1578673430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOOLITTLE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | U | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934995 | ||||||||
| FaxNumber: | 3604934457 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934995 | ||||||||
| FaxNumber: | 3604934457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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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 | PT00006804 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8333921 | 05 | WA | MEDICAID | 0164913 | 01 | WA | DEPT OF LABOR & INDUSTRIES | OTHER |