Provider Demographics
NPI:1508935172
Name:DAWES, JENNIFER LEANNE (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANNE
Last Name:DAWES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 SUNSET PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1546
Mailing Address - Country:US
Mailing Address - Phone:360-856-4200
Mailing Address - Fax:360-856-4220
Practice Address - Street 1:638 SUNSET PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1546
Practice Address - Country:US
Practice Address - Phone:360-856-4200
Practice Address - Fax:360-856-4220
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436172Medicaid
WA0203192OtherDEPT OF LABOR & INDUSTRIE
WAG8857133Medicare PIN