Provider Demographics
NPI:1104016591
Name:BERGSTEDT, JOY DANIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:DANIELLE
Last Name:BERGSTEDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BERGSTEDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:7525 SE 24TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2336
Practice Address - Country:US
Practice Address - Phone:206-230-8320
Practice Address - Fax:206-230-8315
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8868450Medicare PIN