Provider Demographics
NPI:1689785446
Name:FLAHERTY, LORRAINE MAZELIS (PT)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:MAZELIS
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LORRAINE
Other - Middle Name:RACHEL
Other - Last Name:MAZELIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 TERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-689-6559
Mailing Address - Fax:206-689-8365
Practice Address - Street 1:4027 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4920
Practice Address - Country:US
Practice Address - Phone:425-304-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
WAPT00009724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2058904Medicaid
WA60559UOtherREGENCE BLUE SHIELD PIN
WAPT00009724OtherPT LICENSE