Provider Demographics
NPI:1497043699
Name:MATTSON, CHRISTINE LOUIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUIE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LISA
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8009 S 180TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1042
Mailing Address - Country:US
Mailing Address - Phone:425-226-7827
Mailing Address - Fax:425-251-5757
Practice Address - Street 1:8009 S 180TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1042
Practice Address - Country:US
Practice Address - Phone:425-226-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60167112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist