Provider Demographics
NPI:1659439966
Name:FORE, JOHN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:FORE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17414 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12121 NORTHUP WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1928
Practice Address - Country:US
Practice Address - Phone:425-895-8436
Practice Address - Fax:425-895-8110
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3120217OtherAETNA (HMO, QPOS, US)
WA8378671Medicaid
WA0168404OtherLABOR AND INDUSTRY
WA7561142OtherAETNA (PPO, POS, EPO)
WA11362195OtherFIRST HEALTH
WA8378671Medicaid