Provider Demographics
NPI:1780760884
Name:CARRIVEAU, WILLIAM JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:CARRIVEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 5TH AVE NE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-367-6477
Mailing Address - Fax:206-367-7748
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-367-6477
Practice Address - Fax:206-367-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335929Medicaid
WA0068096OtherLABOR & INDUSTRIES
WACA9050OtherREGENCE BLUESHIELD
WA8335929Medicaid