Provider Demographics
NPI:1386970887
Name:DUSELL, ANNALISE D (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:D
Last Name:DUSELL
Suffix:
Gender:F
Credentials:PT, 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 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-316-8046
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:4220 132ND ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-8999
Practice Address - Country:US
Practice Address - Phone:425-686-7655
Practice Address - Fax:425-341-9060
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0325566OtherL & I
WA0325495OtherL & I
WA0325524OtherL & I
WA0325564OtherL & I
WAG8928722Medicare PIN
WAG8927964Medicare PIN
WA0325524OtherL & I
WAG8933143Medicare PIN
WA0325566OtherL & I