Provider Demographics
NPI:1447505698
Name:NIGHT, THERESA A (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:NIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:FABRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3743 SW SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3635
Mailing Address - Country:US
Mailing Address - Phone:310-562-8421
Mailing Address - Fax:
Practice Address - Street 1:3743 SW SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:310-562-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15224225100000X
WAPT60312182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0330396OtherWA L&I
WA1447505698Medicaid
WAG8916163Medicare PIN
WAG8933194Medicare PIN