Provider Demographics
NPI:1033742804
Name:BRECTO, CIERA JOY (PTA)
Entity Type:Individual
Prefix:
First Name:CIERA
Middle Name:JOY
Last Name:BRECTO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 NW LEARY WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5140
Mailing Address - Country:US
Mailing Address - Phone:206-782-0218
Mailing Address - Fax:206-782-1892
Practice Address - Street 1:1455 NW LEARY WAY STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5140
Practice Address - Country:US
Practice Address - Phone:206-782-0218
Practice Address - Fax:206-782-1892
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61002244225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant