Provider Demographics
NPI:1568579928
Name:DUMELIN, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUMELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19217 36TH AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5751
Mailing Address - Country:US
Mailing Address - Phone:425-670-9991
Mailing Address - Fax:425-670-9995
Practice Address - Street 1:19217 36TH AVE W STE 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5751
Practice Address - Country:US
Practice Address - Phone:425-670-9991
Practice Address - Fax:425-670-9995
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00009470OtherLICENSE #