Provider Demographics
NPI:1023319175
Name:FISHER, JESSICA LE ANNE (PTA, LMP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LE ANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PTA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 2ND AVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:206-624-4020
Mailing Address - Fax:
Practice Address - Street 1:2505 2ND AVE
Practice Address - Street 2:100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1452
Practice Address - Country:US
Practice Address - Phone:206-624-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60180214172M00000X
WAP160657620225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No172M00000XOther Service ProvidersMechanotherapist