Basic Information
| Provider Information | |||||||||
| NPI: | 1649778150 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MOORMAN | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | JOHANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21753 SE 299TH WAY | ||||||||
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| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980429224 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 194TH ST SW | ||||||||
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| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256709987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2018 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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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 | 225200000X | P160763192 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.