Provider Demographics
NPI:1841868775
Name:MCVARISH, NICOLE L (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MCVARISH
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 1:17012 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5315
Mailing Address - Country:US
Mailing Address - Phone:206-788-8807
Mailing Address - Fax:866-329-2785
Practice Address - Street 1:17012 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5315
Practice Address - Country:US
Practice Address - Phone:206-788-8807
Practice Address - Fax:866-329-2785
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60968663208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60968663OtherSTATE LICENSE