Provider Demographics
NPI:1902113061
Name:VERMILLION, JOHN ANDREW (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:VERMILLION
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 320TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5359
Mailing Address - Country:US
Mailing Address - Phone:253-839-2727
Mailing Address - Fax:253-839-6081
Practice Address - Street 1:1300 S 320TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5359
Practice Address - Country:US
Practice Address - Phone:253-839-2727
Practice Address - Fax:253-839-6081
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60148721225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant