Provider Demographics
NPI:1154303766
Name:FLETCHER, WILLIAM J (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:1109 FRONTIER CIR E
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3442
Practice Address - Country:US
Practice Address - Phone:425-377-1290
Practice Address - Fax:425-377-1169
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00005864225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA135595OtherLABOR & INDUSTRIES
WA3710FLOtherREGENCE BLUE SHIELD
1909340OtherFIRST HEALTH