Provider Demographics
NPI:1962458679
Name:ESSENBERG, VERN J JR (MPT)
Entity Type:Individual
Prefix:
First Name:VERN
Middle Name:J
Last Name:ESSENBERG
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:7727 40TH ST W
Practice Address - Street 2:SUITE A
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3146
Practice Address - Country:US
Practice Address - Phone:253-460-1362
Practice Address - Fax:253-460-6628
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44698OtherLABOR & INDUSTRIES
WA7701ESOtherREGENCE BLUESHIELD
WA8930575OtherL&I CRIME VICTIMS PRGM
WA8346850Medicaid
WA44698OtherLABOR & INDUSTRIES