Provider Demographics
NPI:1962440982
Name:MARGARET VANDERWAERDEN PT PLLC
Entity Type:Organization
Organization Name:MARGARET VANDERWAERDEN PT PLLC
Other - Org Name:ALPHA PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERWAERDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-481-0236
Mailing Address - Street 1:17330 135TH AVE
Mailing Address - Street 2:STE 1C
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-481-0236
Mailing Address - Fax:425-481-8266
Practice Address - Street 1:17330 135TH AVE
Practice Address - Street 2:STE 1C
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-481-0236
Practice Address - Fax:425-481-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7026115Medicaid
8932336OtherWA STATE CRIME VICTIMS
WA49757OtherL & I STATE WORKMANS COMP
WAAL0173OtherREGENEE BLUE SHIELD
WA49757OtherL & I STATE WORKMANS COMP
=========OtherCOMMERCIAL
8932336OtherWA STATE CRIME VICTIMS