Organization
PROVAIL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HATZENBELER (CEO)
(206) 826-1044
Entity
Organization
Contact information
Practice address
12550 AURORA AVE N, SEATTLE, WA 98133-8036
(206) 363-7303
Mailing address
12550 AURORA AVE N, SEATTLE, WA 98133-8036
(206) 363-7303
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
OT60281347
WA
Other
Enumeration date
07/03/2012
Last updated
07/03/2012
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