1598591273 NPI number — MS. GEORGIA LEIGH ILIGANOA FARTHING DPT

Table of content: MS. GEORGIA LEIGH ILIGANOA FARTHING DPT (NPI 1598591273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598591273 NPI number — MS. GEORGIA LEIGH ILIGANOA FARTHING DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARTHING
Provider First Name:
GEORGIA
Provider Middle Name:
LEIGH ILIGANOA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1598591273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4005 WALLINGFORD AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98103-8218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-829-8269
Provider Business Mailing Address Fax Number:
206-829-8594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4689 MARTIN LUTHER KING JR WAY S STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-327-9907
Provider Business Practice Location Address Fax Number:
206-327-9928
Provider Enumeration Date:
09/10/2024

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:  PT61565658 , 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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