Provider Demographics
NPI:1932682762
Name:FIELDS, HARLEY (ATC/L, PTA)
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:ATC/L, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 12TH AVE SE APT 106
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2364
Mailing Address - Country:US
Mailing Address - Phone:478-494-3544
Mailing Address - Fax:
Practice Address - Street 1:2755 MOTTMAN RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-5684
Practice Address - Country:US
Practice Address - Phone:360-352-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608883192081S0010X
WA60888330225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty