Provider Demographics
NPI:1497185565
Name:SIMS, LINA M (DPT)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:M
Last Name:SIMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:M
Other - Last Name:PERUGINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:4545 41ST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4220
Practice Address - Country:US
Practice Address - Phone:206-932-8363
Practice Address - Fax:206-932-4973
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60415275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01783834OtherRR MEDICARE
WA0349711OtherWA L&I
WA1497185565Medicaid
WAP01783834OtherRR MEDICARE
WA1497185565Medicaid