Provider Demographics
NPI:1356738116
Name:FRYSZTACKI, VENESSA (BS, LMP)
Entity type:Individual
Prefix:MS
First Name:VENESSA
Middle Name:
Last Name:FRYSZTACKI
Suffix:
Gender:F
Credentials:BS, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 EVANSTON AVE N
Mailing Address - Street 2:#316
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8626
Mailing Address - Country:US
Mailing Address - Phone:206-718-2864
Mailing Address - Fax:206-632-1081
Practice Address - Street 1:3417 EVANSTON AVE N
Practice Address - Street 2:#316
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8626
Practice Address - Country:US
Practice Address - Phone:206-718-2864
Practice Address - Fax:206-632-1081
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60314719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist