Provider Demographics
NPI:1518145085
Name:PERTOLDOVA, MAGDALENA (PT)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:PERTOLDOVA
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 1:1417 116TH AVE NE
Mailing Address - Street 2:STE. 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3821
Mailing Address - Country:US
Mailing Address - Phone:425-688-5905
Mailing Address - Fax:
Practice Address - Street 1:914 NW 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3039
Practice Address - Country:US
Practice Address - Phone:971-244-9000
Practice Address - Fax:971-244-9005
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60107067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist