Provider Demographics
NPI:1407419484
Name:DEGEFA, FIYORELA TESSEMA (PTA)
Entity Type:Individual
Prefix:
First Name:FIYORELA
Middle Name:TESSEMA
Last Name:DEGEFA
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 1:7035 S 133RD ST UNIT B301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-5040
Mailing Address - Country:US
Mailing Address - Phone:206-694-3716
Mailing Address - Fax:
Practice Address - Street 1:8811 176TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9724
Practice Address - Country:US
Practice Address - Phone:253-455-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60894275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant