Provider Demographics
NPI:1245286699
Name:BIELSER, JOHN MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BIELSER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:9516 STATE AVE
Practice Address - Street 2:STE B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2277
Practice Address - Country:US
Practice Address - Phone:360-658-8857
Practice Address - Fax:360-659-8296
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00004090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8870781Medicare PIN
GAB05312Medicare PIN