Provider Demographics
NPI:1184934564
Name:CLEVENGER, MOLLY M (DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:CLEVENGER
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:PO BOX 99483
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98139
Mailing Address - Country:US
Mailing Address - Phone:206-660-1218
Mailing Address - Fax:206-494-7676
Practice Address - Street 1:2560 32ND AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3220
Practice Address - Country:US
Practice Address - Phone:206-447-1570
Practice Address - Fax:206-447-1592
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60183689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0287943OtherL & I
WA0136CLOtherREGENCE
WA0140CLOtherREGENCE
WA0271060OtherDEPT OF L&I
WA0137CLOtherREGENCE
WA0138CLOtherREGENCE
WA0139CLOtherREGENCE
WA0141CLOtherREGENCE
WA0270625OtherDEPT OF L&I
WA0271119OtherDEPT OF L&I
WA1184934564OtherDSHS
WA0271112OtherDEPT OF L&I
WA0136CLOtherREGENCE
WA0271119OtherDEPT OF L&I
WA0271060OtherDEPT OF L&I
WAG8906384Medicare UPIN
WA0271112OtherDEPT OF L&I
WAG8895655Medicare PIN