Provider Demographics
NPI:1275929317
Name:LAVAVESHKUL, BRIDGET (DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:LAVAVESHKUL
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 1:610 GALER ST
Mailing Address - Street 2:APT. 125
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3380
Mailing Address - Country:US
Mailing Address - Phone:785-760-4146
Mailing Address - Fax:
Practice Address - Street 1:7454 NEWCASTLE GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-9176
Practice Address - Country:US
Practice Address - Phone:425-543-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60349535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist