Provider Demographics
NPI:1447642301
Name:RUNDELL, SHAWN MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MARIE
Last Name:RUNDELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 COLLEGE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3535
Mailing Address - Country:US
Mailing Address - Phone:303-818-9337
Mailing Address - Fax:
Practice Address - Street 1:3424 MERIDIAN AVE N
Practice Address - Street 2:#13
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9180
Practice Address - Country:US
Practice Address - Phone:303-818-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60022077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist