Provider Demographics
NPI:1336245711
Name:ROGERS FANUCCHI, ELAINE MARGARET (PT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARGARET
Last Name:ROGERS FANUCCHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MARGARET
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1660 S COLUMBIAN WAY STOP 128
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2231
Mailing Address - Fax:206-764-2799
Practice Address - Street 1:1660 S COLUMBIAN WAY STOP 128
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2231
Practice Address - Fax:206-764-2799
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009788225100000X
CAPT20704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist