Provider Demographics
NPI:1871579144
Name:DIANGELIS, THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DIANGELIS
Suffix:
Gender:M
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 1:19217 36TH AVE W
Mailing Address - Street 2:STE 102
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5751
Mailing Address - Country:US
Mailing Address - Phone:425-670-9991
Mailing Address - Fax:425-670-9995
Practice Address - Street 1:19217 36TH AVE W
Practice Address - Street 2:STE 102
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5751
Practice Address - Country:US
Practice Address - Phone:425-670-9991
Practice Address - Fax:425-670-9995
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60255361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0288715OtherWA STATE DEPT. OF LABOR AND INDUSTRIES
WAG8918189Medicare PIN
WAG8907519Medicare PIN