Healthcare Provider Details

I. General information

NPI: 1275341125
Provider Name (Legal Business Name): FASA FAMILY WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 RACQUET LN
YAKIMA WA
98902-6109
US

IV. Provider business mailing address

PO BOX 825159, DEPARTMENT S
PHILADELPHIA PA
19182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-225-3668
  • Fax:
Mailing address:
  • Phone: 509-225-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

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