Provider Demographics
NPI:1235442138
Name:DURBAN, EMILY NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:DURBAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 WINTERGREEN LN NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5147
Mailing Address - Country:US
Mailing Address - Phone:206-223-6999
Mailing Address - Fax:206-842-3711
Practice Address - Street 1:1344 WINTERGREEN LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-5147
Practice Address - Country:US
Practice Address - Phone:206-223-6999
Practice Address - Fax:206-842-3711
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60160961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0265601OtherDEPT OF L&I
WA0100DUOtherREGENCE
WA0265600OtherDEPT OF L&I
WA0265602OtherDEPT OF L&I
WA0265601OtherDEPT OF L&I
WA0100DUOtherREGENCE
WAG8893399Medicare PIN