Provider Demographics
NPI:1710275003
Name:BAULING, ZACHARY P (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:P
Last Name:BAULING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:428 1ST AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4018
Practice Address - Country:US
Practice Address - Phone:206-352-0105
Practice Address - Fax:206-352-0106
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60230931261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710275003Medicaid
P01797621OtherRR MEDICARE
WAG8961557Medicare PIN
WAG8914108Medicare PIN