Provider Demographics
NPI:1497784482
Name:HASSENAUER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HASSENAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2549
Mailing Address - Country:US
Mailing Address - Phone:360-825-2210
Mailing Address - Fax:360-825-1126
Practice Address - Street 1:864 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2549
Practice Address - Country:US
Practice Address - Phone:360-825-2210
Practice Address - Fax:360-825-1126
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8867004Medicare PIN