Provider Demographics
NPI:1871975110
Name:THE ATHLETE EXPERIENCE
Entity type:Organization
Organization Name:THE ATHLETE EXPERIENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT, CSCS
Authorized Official - Phone:206-914-9666
Mailing Address - Street 1:2818 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4841
Mailing Address - Country:US
Mailing Address - Phone:206-641-7733
Mailing Address - Fax:206-641-3272
Practice Address - Street 1:2818 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4841
Practice Address - Country:US
Practice Address - Phone:206-641-7733
Practice Address - Fax:206-641-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT4189261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation