Provider Demographics
NPI:1689496366
Name:CONSCIOUS RESET PLLC
Entity type:Organization
Organization Name:CONSCIOUS RESET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTEYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:833-777-2500
Mailing Address - Street 1:4730 UNIVERSITY WAY NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4424
Mailing Address - Country:US
Mailing Address - Phone:833-777-2500
Mailing Address - Fax:
Practice Address - Street 1:5135 S BANGOR ST UNIT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-2108
Practice Address - Country:US
Practice Address - Phone:833-777-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy