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General NPI Number Information
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NPI Number | 1043643422
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Entity Type | Individual
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Provider Name | MELISSA JENNINGS FABRY THOMAS DPT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 728 N 79TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4712
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Country | US
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Telephone | 206-696-4383
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Fax |
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Provider Business Mailing Address
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Address Line | 728 N 79TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4712
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Country | US
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Telephone | 206-696-4383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60369831
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License Number State | WA
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