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NPI Code Detail

MEDICARE: MRS. TRICIA ANN FONG MSPT

MEDICARE:  MRS. TRICIA ANN FONG  MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist26066CA
2225100000XPhysical TherapistPT60736195WA

General Provider Information

NPI Number : 1336224591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRICIA ANN FONG MSPT
Provider Business Mailing Address
First Line : 563 MADISON AVE N
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-1768
Country : US
Telephone Number : 206-855-8880
Fax Number : 206-855-8465
Provider Business Practice Location Address
First Line : 563 MADISON AVE N
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-1768
Country : US
Telephone Number : 206-855-8880
Fax Number : 206-855-8465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 12/28/2020

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Directions to “ MRS. TRICIA ANN FONG MSPT” Practice Location

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