Provider Demographics
NPI:1881967768
Name:AGLUBAT, JENNIFER ROSE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:AGLUBAT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2312
Mailing Address - Country:US
Mailing Address - Phone:808-348-9109
Mailing Address - Fax:
Practice Address - Street 1:1500 WESTLAKE AVE N STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3036
Practice Address - Country:US
Practice Address - Phone:206-268-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38793225100000X
WAPT60346329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8918568Medicare UPIN