Provider Demographics
NPI:1740688902
Name:OOT SPECIALISTS OF PUGET SOUND, PS
Entity type:Organization
Organization Name:OOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-449-2471
Mailing Address - Street 1:2728 E MAIN AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372
Mailing Address - Country:US
Mailing Address - Phone:253-848-0131
Mailing Address - Fax:253-840-6787
Practice Address - Street 1:2728 E MAIN AVE SUITE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-848-0131
Practice Address - Fax:253-840-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty