Provider Demographics
NPI:1295820884
Name:MARIN, AUDRA ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:ANNE
Last Name:MARIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHICAGO BLVD S
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047
Mailing Address - Country:US
Mailing Address - Phone:206-384-0798
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
Practice Address - Country:US
Practice Address - Phone:206-242-5186
Practice Address - Fax:206-241-8467
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist