Provider Demographics
NPI:1790996718
Name:CORRADO, CARLA (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:CORRADO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3018
Mailing Address - Country:US
Mailing Address - Phone:206-550-4015
Mailing Address - Fax:
Practice Address - Street 1:5621 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2619
Practice Address - Country:US
Practice Address - Phone:206-729-1405
Practice Address - Fax:206-324-0543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000040962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic