Provider Demographics
NPI:1982123782
Name:HANEY, CARLA GERETTE (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:GERETTE
Last Name:HANEY
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 1:1218 3RD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3008
Mailing Address - Country:US
Mailing Address - Phone:206-447-5619
Mailing Address - Fax:206-546-2228
Practice Address - Street 1:1227 N 205TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3214
Practice Address - Country:US
Practice Address - Phone:206-546-2220
Practice Address - Fax:206-546-2228
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist