Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00005864 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00005864 | WA |
NPI | 1154303766 |
---|---|
Provider Name | William J Fletcher |
First Address | Bellevue, WA 98005-2461 |
Second Address | Lake Stevens, WA 98258-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135595 | LABOR & INDUSTRIES (01) | WA |
1909340 | FIRST HEALTH (01) | |
3710FL | REGENCE BLUE SHIELD (01) | WA |