Provider Demographics
NPI:1902202740
Name:VANDERVORT, PHYLLIS (PT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:VANDERVORT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:LEIGH
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7726 CENTER BLVD SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-8748
Mailing Address - Country:US
Mailing Address - Phone:425-396-7778
Mailing Address - Fax:425-396-7097
Practice Address - Street 1:7726 CENTER BLVD SE
Practice Address - Street 2:SUITE 220
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8748
Practice Address - Country:US
Practice Address - Phone:425-396-7778
Practice Address - Fax:425-396-7097
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60418213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist