Provider Demographics
NPI:1861833766
Name:MIYAZAKI, NANCY ANN (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:MIYAZAKI
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 1:4233 182ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9719
Mailing Address - Country:US
Mailing Address - Phone:425-747-7014
Mailing Address - Fax:
Practice Address - Street 1:1601 EAST YESLER WAY
Practice Address - Street 2:SEATTLE KEIRO
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5640
Practice Address - Country:US
Practice Address - Phone:206-323-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist