Basic Information
| Provider Information | |||||||||
| NPI: | 1831459312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VU | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MYLAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 KIRKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980336503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256293502 | ||||||||
| FaxNumber: | 4256293517 | ||||||||
| Practice Location | |||||||||
| Address1: | 6704 NE 181ST ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | KENMORE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980284890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254194363 | ||||||||
| FaxNumber: | 4254194969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2012 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60267157 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.