Provider Demographics
NPI:1972962512
Name:MERCHANT, MARIYAM (MPT)
Entity Type:Individual
Prefix:
First Name:MARIYAM
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8362 NE 140TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9707
Mailing Address - Country:US
Mailing Address - Phone:850-320-3383
Mailing Address - Fax:
Practice Address - Street 1:12501 BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2509
Practice Address - Country:US
Practice Address - Phone:425-450-9801
Practice Address - Fax:425-450-9778
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60593851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist