1295040764 NPI number — DR. ZACHARY IAN STEELE DPT

Table of content: DR. ZACHARY IAN STEELE DPT (NPI 1295040764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295040764 NPI number — DR. ZACHARY IAN STEELE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
ZACHARY
Provider Middle Name:
IAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1295040764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17110 SE 268TH PL
Provider Second Line Business Mailing Address:
APT H202
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-7314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-413-4427
Provider Business Mailing Address Fax Number:
425-413-4402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26837 MAPLE VALLEY BLACK DIAMOND RD SE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038-9917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-413-4427
Provider Business Practice Location Address Fax Number:
425-413-4402
Provider Enumeration Date:
08/09/2010

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:  PT60159664 , 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)