Healthcare Provider Details

I. General information

NPI: 1861417768
Provider Name (Legal Business Name): PEJA PHYLLIS SCHUSSLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 SPRING ST
FRIDAY HARBOR WA
98250-9376
US

IV. Provider business mailing address

849 SPRING ST
FRIDAY HARBOR WA
98250-9376
US

V. Phone/Fax

Practice location:
  • Phone: 360-370-5226
  • Fax: 360-370-5559
Mailing address:
  • Phone: 360-370-5226
  • Fax: 360-370-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00007439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: