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General NPI Number Information
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NPI Number | 1679979769
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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 | 11/17/2014
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1220 W 1ST ST SUITE B
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City | CENTRALIA
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State | WA
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Zip | 98531-3018
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Country | US
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Telephone | 360-736-4151
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Fax |
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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 | 360-338-0004
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Fax | 360-515-0744
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 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 #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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