Provider Demographics
NPI:1790511905
Name:MCINTYRE, ALISE MARITA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALISE
Middle Name:MARITA
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W MCGRAW ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3208
Mailing Address - Country:US
Mailing Address - Phone:206-281-7970
Mailing Address - Fax:425-746-2471
Practice Address - Street 1:3200 W MCGRAW ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3208
Practice Address - Country:US
Practice Address - Phone:206-281-7970
Practice Address - Fax:425-746-2471
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61594574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist