Provider Demographics
NPI:1326044629
Name:FAIRHART, ELEE MARCEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ELEE
Middle Name:MARCEL
Last Name:FAIRHART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0009
Mailing Address - Country:US
Mailing Address - Phone:360-496-5335
Mailing Address - Fax:360-496-5181
Practice Address - Street 1:148 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-5335
Practice Address - Fax:360-496-5181
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8334781Medicaid
WA131920OtherL & I
WAAB09868Medicare ID - Type Unspecified