Provider Demographics
NPI:1356479620
Name:MOEN, ERIK (PT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:MOEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 NE 175TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4800
Mailing Address - Country:US
Mailing Address - Phone:425-482-2453
Mailing Address - Fax:425-482-2452
Practice Address - Street 1:6161 NE 175TH ST
Practice Address - Street 2:STE 203
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4800
Practice Address - Country:US
Practice Address - Phone:425-482-2453
Practice Address - Fax:425-482-2452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT5791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist