Provider Demographics
NPI:1548410632
Name:HEBERT, AUTUMN NOEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:NOEL
Last Name:HEBERT
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 1:15623 1ST AVE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1292
Mailing Address - Country:US
Mailing Address - Phone:206-444-6320
Mailing Address - Fax:206-444-6302
Practice Address - Street 1:15623 1ST AVE S
Practice Address - Street 2:SUITE C
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1292
Practice Address - Country:US
Practice Address - Phone:206-444-6320
Practice Address - Fax:206-444-6302
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist