Provider Demographics
NPI:1972273985
Name:MITSUI, EMMA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MITSUI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11915 26TH PL SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2408
Mailing Address - Country:US
Mailing Address - Phone:206-755-3159
Mailing Address - Fax:
Practice Address - Street 1:1500 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2338
Practice Address - Country:US
Practice Address - Phone:206-735-4414
Practice Address - Fax:206-735-3166
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61180300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist