Healthcare Provider Details

I. General information

NPI: 1023319175
Provider Name (Legal Business Name): JESSICA LE ANNE FISHER P.T.A, L.M.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 2ND AVE 100
SEATTLE WA
98121-1452
US

IV. Provider business mailing address

2505 2ND AVE, SUITE 100
SEATTLE WA
98121
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-4020
  • Fax:
Mailing address:
  • Phone: 206-624-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60180214
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160657620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: