Provider Demographics
NPI:1518657519
Name:LUX, EMMA GRACE ZYLSTRA (BA, DPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:GRACE ZYLSTRA
Last Name:LUX
Suffix:
Gender:F
Credentials:BA, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 140TH AVE NE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6928
Mailing Address - Country:US
Mailing Address - Phone:425-481-1744
Mailing Address - Fax:425-483-1774
Practice Address - Street 1:17000 140TH AVE NE UNIT 303
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6928
Practice Address - Country:US
Practice Address - Phone:425-481-1744
Practice Address - Fax:425-483-1774
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60861146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist