Provider Demographics
NPI:1043643422
Name:THOMAS, MELISSA JENNINGS FABRY (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JENNINGS FABRY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N 79TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4712
Mailing Address - Country:US
Mailing Address - Phone:206-696-4383
Mailing Address - Fax:
Practice Address - Street 1:728 N 79TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4712
Practice Address - Country:US
Practice Address - Phone:206-696-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60369831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01276059OtherMEDICARE RAILROAD
WA0316275OtherDEPT. OF LABOR AND INDUSTRIES
WA1043643422Medicaid
WAG8924007Medicare PIN