Provider Demographics
NPI:1346406360
Name:VU, GWENDOLYN P (MPT)
Entity Type:Individual
Prefix:MISS
First Name:GWENDOLYN
Middle Name:P
Last Name:VU
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 1ST AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1306
Mailing Address - Country:US
Mailing Address - Phone:248-802-0762
Mailing Address - Fax:
Practice Address - Street 1:4700 SW ADMIRAL WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2316
Practice Address - Country:US
Practice Address - Phone:206-664-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist