Provider Demographics
NPI:1356409650
Name:MAJERUS, MANDIE DONETTE (MSPT)
Entity type:Individual
Prefix:MS
First Name:MANDIE
Middle Name:DONETTE
Last Name:MAJERUS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 KIRKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6503
Mailing Address - Country:US
Mailing Address - Phone:425-629-3502
Mailing Address - Fax:425-629-3517
Practice Address - Street 1:209 KIRKLAND AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6503
Practice Address - Country:US
Practice Address - Phone:425-629-3502
Practice Address - Fax:425-629-3517
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8890183Medicare PIN