Provider Demographics
NPI:1306597703
Name:SIJALBO, CHANEL (DPT)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:SIJALBO
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 1:18323 98TH AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3358
Mailing Address - Country:US
Mailing Address - Phone:425-371-7070
Mailing Address - Fax:
Practice Address - Street 1:18323 98TH AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:425-371-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301539225100000X
WAPT61670602225100000X
CA301539208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation