Provider Demographics
NPI:1144277948
Name:COUSSENS, FAWN (MSPT)
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:
Last Name:COUSSENS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4415
Mailing Address - Country:US
Mailing Address - Phone:206-632-0163
Mailing Address - Fax:206-932-2353
Practice Address - Street 1:4828 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4415
Practice Address - Country:US
Practice Address - Phone:206-632-0163
Practice Address - Fax:206-932-2353
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist