NPI 1033583182

Jon Mark Wahlstrom, PTA

Practitioner Physical Therapy Assistant Puyallup, WA

Practice location

Address: 7604 145th Street CT E, Puyallup, WA 98375-7095
Phone: (253) 278-2291

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence P160038469 (WA)

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Registry record

NPI: 1033583182
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Nov 2015
Record last updated: 29 Nov 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.