Provider Demographics
NPI:1992127229
Name:REIS, MARISSA (PT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SW 132ND LN APT 412
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-4009
Mailing Address - Country:US
Mailing Address - Phone:206-331-7816
Mailing Address - Fax:
Practice Address - Street 1:1211 SW 132ND LN APT 412
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-4009
Practice Address - Country:US
Practice Address - Phone:206-331-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000091622251G0304X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility