Provider Demographics
NPI:1134643927
Name:DRAHN, THERESA JOANNE (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:JOANNE
Last Name:DRAHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HEFFALUMP LN
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-8421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 WASHBURN PL
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-5528
Practice Address - Country:US
Practice Address - Phone:360-468-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004003208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation