Provider Demographics
NPI:1154456564
Name:BASILE, MILENA F
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:F
Last Name:BASILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-6881
Practice Address - Fax:206-598-2359
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0218067OtherDEPT. OF LABOR & INDUSTRY
WA8943886OtherL&I CRIME VICTIMS
WA4656BAOtherREGENCE BLUE SHIELD
WA911745305-98208-B027OtherTRICARE
WA9274BAOtherREGENCE BLUE SHIELD
WA4656BAOtherREGENCE BLUE SHIELD
WAG8865730Medicare PIN