Provider Demographics
NPI:1407803158
Name:LOW MCGAVIN, TERI (PT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:LOW MCGAVIN
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 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:10207 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4257
Practice Address - Country:US
Practice Address - Phone:425-337-3166
Practice Address - Fax:425-338-4596
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3258LOOtherREGENCE BLUE SHIELD
WA650021416OtherRAILROAD MEDICARE
WA6565LOOtherREGENCE BLUE SHIELD
WA8928438OtherL&I CRIME VICTIMS
WA0273747OtherDEPT OF L&I
WA2253LOOtherREGENCE BLUE SHIELD
WA0042LOOtherREGENCE
WA0273752OtherDEPT OF L&I
WA8336398Medicaid
WA5470289OtherAETNA
WA911745305-98208-A005OtherTRICARE
WA911745305-98208-B007OtherTRICARE
WA0150733OtherDEPT. OF LABOR & INDUSTRY
WA5782LOOtherREGENCE
WAG8897281Medicare PIN
WA911745305-98208-A005OtherTRICARE
WA0273752OtherDEPT OF L&I