Provider Demographics
NPI:1275645848
Name:WAHLBORG, EMILY A (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:WAHLBORG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 S 186TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1841
Mailing Address - Country:US
Mailing Address - Phone:206-257-0829
Mailing Address - Fax:
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-5186
Practice Address - Fax:206-241-8467
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant