Provider Demographics
NPI:1396639068
Name:NEMOTO, ALYSA MAI GOTO (DPT)
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:MAI GOTO
Last Name:NEMOTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 S OTHELLO ST UNIT 570
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4096
Mailing Address - Country:US
Mailing Address - Phone:808-388-8444
Mailing Address - Fax:
Practice Address - Street 1:1801 LIND AVE SW BLDG D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3368
Practice Address - Country:US
Practice Address - Phone:425-227-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU70009251225100000X
WAPT70009250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist