Provider Demographics
NPI:1174808331
Name:FORTUNATO, EMILY S (MS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 STARFIRE WAY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-8502
Mailing Address - Country:US
Mailing Address - Phone:301-588-7888
Mailing Address - Fax:301-588-3419
Practice Address - Street 1:14800 STARFIRE WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8502
Practice Address - Country:US
Practice Address - Phone:301-588-7888
Practice Address - Fax:301-588-3419
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002002255A2300X
WAA1615182322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer