Provider Demographics
NPI:1144458423
Name:WEST, ADRIENNE LESLIE (DPT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LESLIE
Last Name:WEST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 53RD LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8003
Mailing Address - Country:US
Mailing Address - Phone:360-480-1181
Mailing Address - Fax:
Practice Address - Street 1:2700 SIMPSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-537-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60096552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004VIOtherREGENCE
WA0250876OtherL& I
WA1003VIOtherREGENCE
WA1005VIOtherREGENCE
WA1007VIOtherREGENCE
WA8555898OtherDSHS
WA1006VIOtherREGENCE
WA0250876OtherL& I