Basic Information
Provider Information
NPI: 1790871770
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PINSKI
FirstName: JANELLE
MiddleName: L
NamePrefix: MS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WAID-CLEM
OtherFirstName: JANELLE
OtherMiddleName: L
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 1
Mailing Information
Address1: 805 MADISON ST
Address2: SUITE 901
City: SEATTLE
State: WA
PostalCode: 981041172
CountryCode: US
TelephoneNumber: 2062648100
FaxNumber: 2062648689
Practice Location
Address1: 12911 120TH AVE NE
Address2: SUITE H-220
City: KIRKLAND
State: WA
PostalCode: 980343027
CountryCode: US
TelephoneNumber: 4252167075
FaxNumber: 4252167094
Other Information
ProviderEnumerationDate: 10/05/2006
LastUpdateDate: 10/07/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00009115WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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