Provider Demographics
NPI:1598806689
Name:WHITESEL PROTHERAPY
Entity Type:Organization
Organization Name:WHITESEL PROTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:425-889-0776
Mailing Address - Street 1:13120 NE 70TH PL STE 3
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8570
Mailing Address - Country:US
Mailing Address - Phone:425-889-0776
Mailing Address - Fax:425-889-0857
Practice Address - Street 1:13120 NE 70TH PL STE 3
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8570
Practice Address - Country:US
Practice Address - Phone:425-889-0776
Practice Address - Fax:425-889-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA142740OtherDEPT OF L&I
WAG8803009Medicare ID - Type UnspecifiedMEDICARE GROUP