Provider Demographics
NPI:1578858650
Name:MAYFIELD, JOSCELYN M (DPT)
Entity Type:Individual
Prefix:
First Name:JOSCELYN
Middle Name:M
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8612
Mailing Address - Country:US
Mailing Address - Phone:425-455-2630
Mailing Address - Fax:425-451-4390
Practice Address - Street 1:17800 TALBOT RD S
Practice Address - Street 2:SUITE D
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5740
Practice Address - Country:US
Practice Address - Phone:425-277-9096
Practice Address - Fax:425-277-1206
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2015-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT60222805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8905351Medicare UPIN