Provider Demographics
NPI:1790811735
Name:COOMER, ERIN N (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:N
Last Name:COOMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6566
Mailing Address - Country:US
Mailing Address - Phone:206-601-0174
Mailing Address - Fax:
Practice Address - Street 1:106 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6542
Practice Address - Country:US
Practice Address - Phone:206-465-5650
Practice Address - Fax:206-257-5562
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60277365225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8909861Medicare PIN