Healthcare Provider Details

I. General information

NPI: 1255295416
Provider Name (Legal Business Name): REESE FUJIMOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 21ST AVE
SEATTLE WA
98122-4758
US

IV. Provider business mailing address

911 21ST AVE
SEATTLE WA
98122-4758
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-1999
  • Fax:
Mailing address:
  • Phone: 808-381-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70068644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: