Provider Demographics
NPI:1235440744
Name:INDEPENDENCE REHAB
Entity Type:Organization
Organization Name:INDEPENDENCE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-715-2969
Mailing Address - Street 1:2252 BONAIR PL SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1825
Mailing Address - Country:US
Mailing Address - Phone:206-715-2969
Mailing Address - Fax:
Practice Address - Street 1:4611 35TH AVENUE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:206-402-3785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60019740261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy