| Doctor Name: | JODY GUSTAFSON |
| NPI Number: | 1053655860 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PT 00002619 |
| Business Practice Address: | 3330 Monte Villa Pkwy Bothell, WA - 980218972 |
| Business Phone Number: | 4254085570 |
| Business Fax Number: | |
| Mailing Address: | 19705 88th Ave Ne, BOTHELL |
| State: | WA |
| Postal Code: | 980112121 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2012 |
| NPI Last Update Date: | 11/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | PT 00002619 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |