Provider Demographics
NPI:1679608400
Name:NORDBERG, P LYNN (PT)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:LYNN
Last Name:NORDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 170TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2046
Mailing Address - Country:US
Mailing Address - Phone:425-497-2141
Mailing Address - Fax:
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:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00001014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist