1851338255 NPI number — SOLE EXPRESSIONS

Table of content: (NPI 1851338255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851338255 NPI number — SOLE EXPRESSIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLE EXPRESSIONS
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:
ISLAND CREST FOOT AND ANKLE CENTER
Provider Other Organization Name Type Code:
3
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:
1851338255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8015 SE 28TH ST
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-275-9705
Provider Business Mailing Address Fax Number:
425-484-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8015 SE 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
MERCER ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98040-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-275-9705
Provider Business Practice Location Address Fax Number:
425-484-6425
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
ERIKA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
206-275-9705

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO00000743 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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