Provider Demographics
NPI:1568506327
Name:TOLLEFSON, STEVE (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:TOLLEFSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18323 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5246
Mailing Address - Country:US
Mailing Address - Phone:425-806-5721
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:18120 BOTHELL WAY NE
Practice Address - Street 2:SUITE A1
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1943
Practice Address - Country:US
Practice Address - Phone:425-488-6640
Practice Address - Fax:425-488-5424
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8350167Medicaid
WA8350167Medicaid