Provider Demographics
NPI:1780737346
Name:WALDNER, ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALDNER
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 1:2442 NW MARKET ST
Mailing Address - Street 2:P.O BOX 450
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4137
Mailing Address - Country:US
Mailing Address - Phone:206-715-1884
Mailing Address - Fax:206-783-0867
Practice Address - Street 1:4110 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8000
Practice Address - Country:US
Practice Address - Phone:206-715-1884
Practice Address - Fax:206-783-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist