Provider Demographics
NPI:1942408596
Name:KNEEFOOTANKLECENTER, PLLC
Entity Type:Organization
Organization Name:KNEEFOOTANKLECENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-6060
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3060
Mailing Address - Country:US
Mailing Address - Phone:425-899-6060
Mailing Address - Fax:425-899-6078
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 220
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3060
Practice Address - Country:US
Practice Address - Phone:425-899-6060
Practice Address - Fax:425-899-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029212207X00000X
WAMD00047525207X00000X
WAMD00041579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADF9944OtherRAILROAD MEDICARE
WAGAB 04993Medicare PIN
WA6023180001Medicare NSC
WADF9944OtherRAILROAD MEDICARE