Provider Demographics
NPI:1083802615
Name:ICE-TSENG, SUMMER DENALI (DPT)
Entity Type:Individual
Prefix:MISS
First Name:SUMMER
Middle Name:DENALI
Last Name:ICE-TSENG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18323 BOTHELL EVERETT HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5246
Mailing Address - Country:US
Mailing Address - Phone:425-806-5700
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:18120 BOTHELL WAY NE STE A1
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1943
Practice Address - Country:US
Practice Address - Phone:425-488-6640
Practice Address - Fax:425-488-5424
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist