Provider Demographics
NPI:1124399357
Name:FUQUA-WHITLEY, DAWNA SUE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAWNA
Middle Name:SUE
Last Name:FUQUA-WHITLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9319 244TH ST SW
Mailing Address - Street 2:Q201
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-7506
Mailing Address - Country:US
Mailing Address - Phone:404-610-6071
Mailing Address - Fax:
Practice Address - Street 1:1545 NW MARKET ST
Practice Address - Street 2:APT 413
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5250
Practice Address - Country:US
Practice Address - Phone:404-610-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60262116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist