Healthcare Provider Details

I. General information

NPI: 1174091193
Provider Name (Legal Business Name): FASA FAMILY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 CORPORATE CENTER CT SE STE A
LACEY WA
98503-5952
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-3338
  • Fax:
Mailing address:
  • Phone: 360-754-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE EUGENE HESS
Title or Position: OWNER
Credential:
Phone: 360-754-3338