Provider Demographics
NPI:1316265804
Name:MEDIGOVIK, STANISLAVA (DPT)
Entity type:Individual
Prefix:
First Name:STANISLAVA
Middle Name:
Last Name:MEDIGOVIK
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 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-462-5006
Mailing Address - Fax:425-462-5019
Practice Address - Street 1:3101 NORTHUP WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1435
Practice Address - Country:US
Practice Address - Phone:425-462-5006
Practice Address - Fax:425-462-5019
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60571720225100000X, 225100000X
PAPTO20512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
306208OtherUNISON
WA2056536Medicaid
PA1316265804OtherBRAVO
PA3779584000OtherIBC
PA102455719-0001Medicaid
DE1316265804Medicaid
PA30072582OtherKEYSTONE MERCY
2502494OtherPA BLUE SHIELD
DE1316265804Medicaid