Provider Demographics
NPI:1760124689
Name:MERCADO, JOHN JAY MARCELO
Entity Type:Individual
Prefix:
First Name:JOHN JAY MARCELO
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 GREENWOOD AVE N APT N502
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3678
Mailing Address - Country:US
Mailing Address - Phone:361-537-9464
Mailing Address - Fax:
Practice Address - Street 1:8760 GREENWOOD AVE N APT N502
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3678
Practice Address - Country:US
Practice Address - Phone:361-537-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160668651225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
709350OtherPROFESSIONAL ORGANIZATION