Provider Demographics
NPI:1306056478
Name:THUSAT, DIANE K (PT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:THUSAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:K
Other - Last Name:JANSHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12900 NE 180TH ST
Mailing Address - Street 2:#110
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-483-4270
Mailing Address - Fax:425-483-4268
Practice Address - Street 1:12900 NE 180TH ST
Practice Address - Street 2:#110
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-483-4270
Practice Address - Fax:425-483-4268
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8347551Medicaid
WAAB34050Medicare ID - Type Unspecified