Provider Demographics
NPI:1558640748
Name:DARNELL, ASHLEY DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:DARNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DAWN
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:915 118TH AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3875
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:1804 W UNION AVE
Practice Address - Street 2:STE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2062
Practice Address - Country:US
Practice Address - Phone:532-512-5572
Practice Address - Fax:253-393-9187
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60229097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60229097OtherSTATE LICENSE
WAG8903540Medicare PIN