Basic Information
| Provider Information | |||||||||
| NPI: | 1154303766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11711 NE 12TH ST | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980052461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254509474 | ||||||||
| FaxNumber: | 4254520704 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 FRONTIER CIR E | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LAKE STEVENS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982583442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253771290 | ||||||||
| FaxNumber: | 4253771169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00005864 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251S0007X | PT00005864 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
ID Information
| ID | Type | State | Issuer | Description | 135595 | 01 | WA | LABOR & INDUSTRIES | OTHER | 3710FL | 01 | WA | REGENCE BLUE SHIELD | OTHER | 1909340 | 01 | FIRST HEALTH | OTHER |