Provider Demographics
NPI:1972955201
Name:RAVOTTI, TESSA M (DPT)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:M
Last Name:RAVOTTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:M
Other - Last Name:RAVOTTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:24060 SE KENT KANGLEY RD STE D100
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6801
Practice Address - Country:US
Practice Address - Phone:425-690-3522
Practice Address - Fax:425-690-9522
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60638338225100000X
WAPT60638338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2067441Medicaid