Provider Demographics
NPI:1053000620
Name:DECENA, MARIELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:DECENA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 GREENWOOD AVE N STE S1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3684
Mailing Address - Country:US
Mailing Address - Phone:206-782-5789
Mailing Address - Fax:
Practice Address - Street 1:8750 GREENWOOD AVE N STE S1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3684
Practice Address - Country:US
Practice Address - Phone:206-782-5789
Practice Address - Fax:206-782-5794
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT1312489225200000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant