Provider Demographics
NPI:1588739957
Name:FUJIMOTO-DISTEFANO, ANN AKIKO (DPT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:AKIKO
Last Name:FUJIMOTO-DISTEFANO
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 1:588 SE BISHOP BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5534
Mailing Address - Country:US
Mailing Address - Phone:509-332-7778
Mailing Address - Fax:509-332-7032
Practice Address - Street 1:588 SE BISHOP BLVD STE A
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5534
Practice Address - Country:US
Practice Address - Phone:509-332-7778
Practice Address - Fax:509-332-7032
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8378374Medicaid
WA8378374Medicaid