Basic Information
| Provider Information | |||||||||
| NPI: | 1154456564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASILE | ||||||||
| FirstName: | MILENA | ||||||||
| MiddleName: | F | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24366 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065980502 | ||||||||
| FaxNumber: | 2065980516 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065986881 | ||||||||
| FaxNumber: | 2065982359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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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 | PT00010364 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0218067 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 8943886 | 01 | WA | L&I CRIME VICTIMS | OTHER | 4656BA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 911745305-98208-B027 | 01 | WA | TRICARE | OTHER | 9274BA | 01 | WA | REGENCE BLUE SHIELD | OTHER |