Provider Demographics
NPI:1770566622
Name:STOAKLEY, CORA BUNDY (PT)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:BUNDY
Last Name:STOAKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:ANNE
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:3131 E MADISON ST
Practice Address - Street 2:STE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4263
Practice Address - Country:US
Practice Address - Phone:206-324-5389
Practice Address - Fax:206-324-5391
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8334567Medicaid
WAAB36765Medicare PIN