# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PMG NW WA Physiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740432731
- **Authorized official:** MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1330 ROCKEFELLER AVE, SUITE 230, EVERETT, WA 98201-1676
- **Practice address phone:** (425) 261-4940
- **Practice address fax:** (425) 225-1000
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (425) 358-9786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/21/2008
- **Last updated:** 05/14/2025