Provider Demographics
NPI:1770182685
Name:SECONDEZ, PHILIP AURELIO (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:AURELIO
Last Name:SECONDEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 S RYAN WAY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2035
Mailing Address - Country:US
Mailing Address - Phone:415-312-7574
Mailing Address - Fax:
Practice Address - Street 1:3221 EASTLAKE AVE E STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7125
Practice Address - Country:US
Practice Address - Phone:206-641-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61065289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist