Provider Demographics
NPI:1598178766
Name:BATTISTELLA, TAYA MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:TAYA
Middle Name:MARIE
Last Name:BATTISTELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N LAVENTURE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3901
Mailing Address - Country:US
Mailing Address - Phone:360-428-2700
Mailing Address - Fax:360-428-2700
Practice Address - Street 1:110 N LAVENTURE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3901
Practice Address - Country:US
Practice Address - Phone:360-428-2700
Practice Address - Fax:360-428-2700
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012635225100000X
WAPT60477755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist