Provider Demographics
NPI:1922308063
Name:DETTORI, MALIA WINONA (DPT)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:WINONA
Last Name:DETTORI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:WINONA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 99483
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98139-0483
Mailing Address - Country:US
Mailing Address - Phone:206-660-1218
Mailing Address - Fax:206-494-7676
Practice Address - Street 1:2560 32ND AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3220
Practice Address - Country:US
Practice Address - Phone:206-660-1218
Practice Address - Fax:206-494-7676
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60186839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist