1730704883 NPI number — THE MAMA AND BABY MOBILITY PROJECT

Table of content: (NPI 1730704883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730704883 NPI number — THE MAMA AND BABY MOBILITY PROJECT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MAMA AND BABY MOBILITY PROJECT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730704883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 164TH ST SW APT E107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98087-7836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-922-4458
Provider Business Mailing Address Fax Number:
425-582-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 164TH ST SW APT E107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98087-7836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-922-4458
Provider Business Practice Location Address Fax Number:
425-582-0846
Provider Enumeration Date:
06/15/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
KELSEY
Authorized Official Middle Name:
ZANE
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY
Authorized Official Telephone Number:
360-922-4458

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)