1275651572 NPI number — GARVICE NICHOLSON PT

Table of content: GARVICE NICHOLSON PT (NPI 1275651572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275651572 NPI number — GARVICE NICHOLSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLSON
Provider First Name:
GARVICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1275651572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8225 44TH AVE W
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MUKILTEO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98275-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-353-8797
Provider Business Mailing Address Fax Number:
425-353-8765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8225 44TH AVE W
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MUKILTEO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98275-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-353-8797
Provider Business Practice Location Address Fax Number:
425-353-8765
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  WA00009250 , 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)

  • Identifier: 0182089 . This is a "L&I NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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