Provider Demographics
NPI:1629247291
Name:MARY LEE SNORTELAND PT LLC
Entity Type:Organization
Organization Name:MARY LEE SNORTELAND PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNORTELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-778-2325
Mailing Address - Street 1:4300 198TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6771
Mailing Address - Country:US
Mailing Address - Phone:425-778-2325
Mailing Address - Fax:425-778-7692
Practice Address - Street 1:4300 198TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6771
Practice Address - Country:US
Practice Address - Phone:425-778-2325
Practice Address - Fax:425-778-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8859358Medicare PIN