Provider Demographics
NPI:1700867041
Name:CULLINANE, DAVID E (PT OCS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:CULLINANE
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10504 BROOK LN SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1612
Mailing Address - Country:US
Mailing Address - Phone:253-581-7173
Mailing Address - Fax:
Practice Address - Street 1:2102 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-756-7878
Practice Address - Fax:253-756-9634
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336967Medicaid
WAAB20909Medicare ID - Type Unspecified
WAR11859Medicare UPIN