Provider Demographics
NPI:1851529259
Name:WOODWORTH, MAEVA CHALMERS (DPT)
Entity Type:Individual
Prefix:
First Name:MAEVA
Middle Name:CHALMERS
Last Name:WOODWORTH
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 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:426-646-3901
Practice Address - Street 1:1107 NE 45TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4690
Practice Address - Country:US
Practice Address - Phone:206-545-7844
Practice Address - Fax:206-545-7843
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60101236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8886291Medicare PIN
WAG8907009Medicare PIN