MEDICARE: CONNIE JEAN DE MARIA PTA

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
1	225200000X	Physical Therapy Assistant	P160039700	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P160039700	OTHER	WA	WASHINGTON STATE DEPARTMENT OF HEALTH PHYSICAL THERAPIST ASSISTANT

General Provider Information

NPI Number	:	1659745651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE JEAN DE MARIA PTA

Provider Business Mailing Address
First Line	:	7001 SEAVIEW AVE NW STE 160
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-6021
Country	:	US
Telephone Number	:	206-861-4653
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 FAIRVIEW AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5360
Country	:	US
Telephone Number	:	206-254-1456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2015
Last Update Date	:	11/21/2025

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Directions to “ CONNIE JEAN DE MARIA PTA” Practice Location

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