Provider Demographics
NPI:1437179421
Name:WADA, JOY KUMI (DPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:KUMI
Last Name:WADA
Suffix:
Gender:F
Credentials:DPT, ATC, CSCS
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:KUMI
Other - Last Name:NAKASUJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, ATC, CSCS
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:144 169TH ST S
Practice Address - Street 2:SUITE B
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8201
Practice Address - Country:US
Practice Address - Phone:253-846-8918
Practice Address - Fax:253-846-8126
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8458945Medicaid
WA0211485OtherL&I
WA8861193Medicare PIN