Provider Demographics
NPI:1659329464
Name:FONSECA, MIYE NAKAHARA (D PT)
Entity Type:Individual
Prefix:MS
First Name:MIYE
Middle Name:NAKAHARA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:D PT
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Mailing Address - Street 1:15600 REDMOND WAY NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-883-9089
Mailing Address - Fax:425-869-1355
Practice Address - Street 1:15600 REDMOND WAY NE
Practice Address - Street 2:SUITE 300
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-883-9089
Practice Address - Fax:425-869-1355
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 326412251X0800X
WAPT 000108672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic