Provider Demographics
NPI:1083613103
Name:SUELTENFUSS, MEGHAN E (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:E
Last Name:SUELTENFUSS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-412-1877
Mailing Address - Fax:425-339-4219
Practice Address - Street 1:21401 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7702
Practice Address - Country:US
Practice Address - Phone:425-412-1877
Practice Address - Fax:425-339-4219
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17200225100000X
WAPT60056174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0387629OtherLABOR & INDUSTRIES