Provider Demographics
NPI:1184066078
Name:FIALA, KATJE COLLEEN (LMP)
Entity type:Individual
Prefix:MRS
First Name:KATJE
Middle Name:COLLEEN
Last Name:FIALA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 MAGNOLIA BLVD W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1820
Mailing Address - Country:US
Mailing Address - Phone:425-765-1602
Mailing Address - Fax:
Practice Address - Street 1:433 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5341
Practice Address - Country:US
Practice Address - Phone:425-765-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00020524225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist