Basic Information
| Provider Information | |||||||||
| NPI: | 1598804106 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ABLUTZ | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MPT, CSCS, OCS, CMPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 MINOR AVE | ||||||||
| Address2: | SUTIE 22 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063865600 | ||||||||
| FaxNumber: | 2063865444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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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 | PT00006298 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7095904 | 05 | WA | MEDICAID |