Provider Demographics
NPI:1083212971
Name:VANALLEN, GRACE ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ANNE
Last Name:VANALLEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 112TH AVE NE APT 1210
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8588
Mailing Address - Country:US
Mailing Address - Phone:215-715-8370
Mailing Address - Fax:
Practice Address - Street 1:1188 106TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8612
Practice Address - Country:US
Practice Address - Phone:425-455-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60685837225200000X
PATE011033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant