Provider Demographics
NPI:1558641886
Name:PROSTHETIC SPECIALISTS OF WASHINGTON
Entity Type:Organization
Organization Name:PROSTHETIC SPECIALISTS OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:PERTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:425-576-5050
Mailing Address - Street 1:7047 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5551
Mailing Address - Country:US
Mailing Address - Phone:425-576-5050
Mailing Address - Fax:206-202-0866
Practice Address - Street 1:11417 124TH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4677
Practice Address - Country:US
Practice Address - Phone:425-576-5050
Practice Address - Fax:206-202-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier