Provider Demographics
NPI:1942646336
Name:IN, STELLA HAN (PT)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:HAN
Last Name:IN
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:425-357-8885
Mailing Address - Fax:425-357-8454
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:#106
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-332-1030
Practice Address - Fax:425-332-1035
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2014-08-12
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Provider Licenses
StateLicense IDTaxonomies
WAPT60337482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8920729Medicare PIN