Provider Demographics
NPI:1700204666
Name:AGREGADO, JEANIE
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:
Last Name:AGREGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 17TH ST SE
Mailing Address - Street 2:UNIT 6-E
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6884
Mailing Address - Country:US
Mailing Address - Phone:206-818-4601
Mailing Address - Fax:
Practice Address - Street 1:418 17TH ST SE
Practice Address - Street 2:UNIT 6-E
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6884
Practice Address - Country:US
Practice Address - Phone:206-818-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160054699225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant