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General NPI Number Information
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NPI Number | 1679025902
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Entity Type | Organization
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Legal Business Name | FASA FAMILY WELLNESS, PLLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 404 BLACK HILLS LN SW STE B
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City | OLYMPIA
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State | WA
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Zip | 98502-8148
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Country | US
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Telephone | 360-943-1400
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Fax | 360-943-0660
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 360-754-3338
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Fax | 360-753-4861
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Authorized Official
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Title or Position | OWNER
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Name | TERRENCE EUGENE HESS
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Credential |
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Telephone | 360-754-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0-000-506-137
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License Number State | WA
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