Provider Demographics
NPI:1255472064
Name:HARNESS, ANNAMARIE LEE (MSPT)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:LEE
Last Name:HARNESS
Suffix:
Gender:F
Credentials:MSPT
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 1872
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1872
Mailing Address - Country:US
Mailing Address - Phone:425-486-6079
Mailing Address - Fax:
Practice Address - Street 1:19102 N CREEK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8005
Practice Address - Country:US
Practice Address - Phone:425-486-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist