Provider Demographics
NPI:1043491152
Name:CARSCALLEN, JEREMY (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:CARSCALLEN
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:SAMMAMISH
Other - Middle Name:
Other - Last Name:PT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT, OCS, CSCS
Mailing Address - Street 1:22840 NE 8TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7263
Mailing Address - Country:US
Mailing Address - Phone:425-898-8540
Mailing Address - Fax:
Practice Address - Street 1:22840 NE 8TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7263
Practice Address - Country:US
Practice Address - Phone:425-898-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34113225100000X
WAPT60118627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist