Provider Demographics
NPI:1043765878
Name:SEATTLE ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:SEATTLE ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:VALLEY PROSTHETICS AND ORTHOTICS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPO
Authorized Official - Phone:425-640-2004
Mailing Address - Street 1:6405 218TH ST SW
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2180
Mailing Address - Country:US
Mailing Address - Phone:425-640-2004
Mailing Address - Fax:206-299-9445
Practice Address - Street 1:120 14TH AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3718
Practice Address - Country:US
Practice Address - Phone:253-848-0128
Practice Address - Fax:206-299-9445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEATTLE ORTHOTICS AND PROSTHETICS,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-22
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000071335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1669896973OtherNPI