Provider Demographics
NPI:1427040161
Name:DANIELSON, AMY JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JEAN
Last Name:DANIELSON
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 1:4702 LINDEN AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6535
Mailing Address - Country:US
Mailing Address - Phone:702-275-3640
Mailing Address - Fax:
Practice Address - Street 1:4702 LINDEN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6535
Practice Address - Country:US
Practice Address - Phone:702-275-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1607225100000X
WAPT00010127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5373DAOtherBLUE SHIELD VM
NV100503511Medicaid
39770Medicare ID - Type Unspecified