Provider Demographics
NPI:1396908307
Name:FORTNER, EMILY CHRISTINE (PT60022073)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:FORTNER
Suffix:
Gender:F
Credentials:PT60022073
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 43RD ST
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1771
Mailing Address - Country:US
Mailing Address - Phone:253-970-9193
Mailing Address - Fax:
Practice Address - Street 1:2815 43RD ST
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1771
Practice Address - Country:US
Practice Address - Phone:253-970-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60022073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60022073OtherLICENSE