Provider Demographics
NPI:1558601195
Name:SEATTLE SPINE AND REHABILITATION
Entity Type:Organization
Organization Name:SEATTLE SPINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-861-8200
Mailing Address - Street 1:3213 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-7127
Mailing Address - Country:US
Mailing Address - Phone:206-861-8200
Mailing Address - Fax:
Practice Address - Street 1:3213 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7127
Practice Address - Country:US
Practice Address - Phone:206-861-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60301515273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit