Healthcare Provider Details

I. General information

NPI: 1053000620
Provider Name (Legal Business Name): MARIELLE DECENA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 GREENWOOD AVE N STE S1
SEATTLE WA
98103-3684
US

IV. Provider business mailing address

8750 GREENWOOD AVE N STE S1
SEATTLE WA
98103-3684
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-5789
  • Fax: 206-782-5794
Mailing address:
  • Phone: 206-782-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1312489
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT1312489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: