Individual
JODY GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3330 MONTE VILLA PKWY, BOTHELL, WA 98021-8972
(425) 408-5570
Mailing address
19705 88TH AVE NE, BOTHELL, WA 98011-2121
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 00002619
WA
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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