Provider Demographics
NPI:1578670519
Name:CHUNN, ALICIA DIANE
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:DIANE
Last Name:CHUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:DIANE
Other - Last Name:CARSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3823 DELRIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106
Mailing Address - Country:US
Mailing Address - Phone:206-301-0600
Mailing Address - Fax:206-301-0601
Practice Address - Street 1:3823 DELRIDGE WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106
Practice Address - Country:US
Practice Address - Phone:206-301-0600
Practice Address - Fax:206-301-0601
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAPT600184885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096001624OtherLICENSE #