Basic Information
| Provider Information | |||||||||
| NPI: | 1003150558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTNER | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6207 NE 191ST ST | ||||||||
| Address2: | |||||||||
| City: | KENMORE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980283372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254839229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 MONTE VILLA PKWY | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980218972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254086000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2012 | ||||||||
| LastUpdateDate: | 11/22/2012 | ||||||||
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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 | PT 00002605 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.