Provider Demographics
NPI:1205930948
Name:BULUT-GENCEREN, ILKNUR (PT)
Entity type:Individual
Prefix:
First Name:ILKNUR
Middle Name:
Last Name:BULUT-GENCEREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3029
Mailing Address - Country:US
Mailing Address - Phone:206-447-2220
Mailing Address - Fax:
Practice Address - Street 1:701 5TH AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-7097
Practice Address - Country:US
Practice Address - Phone:206-682-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT10003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA208217OtherLABOR & INDUSTRIES
WA8448243Medicaid
WA8448243Medicaid