Provider Demographics
NPI:1477114650
Name:BATES, NESSAMARIE EUEVA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NESSAMARIE
Middle Name:EUEVA
Last Name:BATES
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 1:1655 SWEDE PASS RD N
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:WA
Mailing Address - Zip Code:99126-9706
Mailing Address - Country:US
Mailing Address - Phone:509-675-1812
Mailing Address - Fax:
Practice Address - Street 1:39 SHORTCUT ROAD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-0290
Practice Address - Country:US
Practice Address - Phone:509-722-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60959403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist