Provider Demographics
NPI:1912105099
Name:FRADET, JANE SCOTT (PT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:SCOTT
Last Name:FRADET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:SCOTT
Other - Last Name:LA FERLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:20305 87TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6215
Mailing Address - Country:US
Mailing Address - Phone:206-463-9782
Mailing Address - Fax:
Practice Address - Street 1:140 S MARION AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3639
Practice Address - Country:US
Practice Address - Phone:360-479-4747
Practice Address - Fax:360-478-6246
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4111589Medicaid
WA4111589Medicaid
WA505240Medicare Oscar/Certification