Provider Demographics
NPI:1972057966
Name:FORSLUND, ELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FORSLUND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20314 84TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6606
Mailing Address - Country:US
Mailing Address - Phone:425-780-0289
Mailing Address - Fax:
Practice Address - Street 1:1909 214TH ST SE STE 300
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4418
Practice Address - Country:US
Practice Address - Phone:425-412-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60658313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist