Provider Demographics
NPI:1710071147
Name:BILLINGSLEY, JEFFREY (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BILLINGSLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1105
Mailing Address - Country:US
Mailing Address - Phone:253-848-2309
Mailing Address - Fax:253-848-8407
Practice Address - Street 1:2520 7TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1105
Practice Address - Country:US
Practice Address - Phone:253-848-2309
Practice Address - Fax:253-848-8407
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7206204Medicaid
WABI5924OtherREGENCE
WAGAB38612Medicare PIN