Provider Demographics
NPI:1245262310
Name:VANDERWAERDEN, MARGARET (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:VANDERWAERDEN
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 1:17330 135TH AVE NE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-481-0236
Mailing Address - Fax:425-481-8266
Practice Address - Street 1:17330 135TH AVE NE
Practice Address - Street 2:SUITE 1C
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-481-0236
Practice Address - Fax:425-481-8266
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2369OtherBLUE SHIELD
911400843OtherAETNA
911400843OtherCOMMERCIAL
8932337OtherWA STATE CRIME VICTIMS
2369OtherWA STATE LABOR AND INDUST
VA2369OtherBLUE SHIELD