Provider Demographics
NPI:1366111916
Name:TOWNSEND, GEORGINA BEATRICE (PTA)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:BEATRICE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVW
Mailing Address - Street 2:STE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:971-364-0611
Mailing Address - Fax:
Practice Address - Street 1:2424 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3814
Practice Address - Country:US
Practice Address - Phone:425-242-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160264709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant