Provider Demographics
NPI:1154466043
Name:DE BEIJL, PAUL (PT, LAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DE BEIJL
Suffix:
Gender:M
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 OLIVE WAY STE 900
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1840
Mailing Address - Country:US
Mailing Address - Phone:206-623-2220
Mailing Address - Fax:206-623-2228
Practice Address - Street 1:1218 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3008
Practice Address - Country:US
Practice Address - Phone:206-447-2220
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002074171100000X
WAPT00005321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8332777OtherINDIVIDUAL MEDICAID
WA105839OtherINDIVIDUAL L&I
WA7101066OtherGROUP MEDICAID
WA1356411011OtherGROUP NPI NUMBER
G8801835OtherMEDICARE INDIVIDUAL UPIN
WA144285OtherGROUP L&I NUMBER
WAG8801833Medicare UPIN