Organization Name: | REDMOND RIDGE PHYSICAL THERAPY LLC |
NPI Number: | 1427397348 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL SHANNON OKELLEY (PRESIDENT) |
Mailing Address: | 14110 Main St Ne Suite A Duvall |
State: | WA US |
Postal Code: | 980198475 |
Phone Number: | 4254297278 |
Fax Number: | 4253419035 |
NPI Enumeration Date: | 02/13/2013 |
NPI Last Update Date: | 02/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |