1093767832 NPI number — MRS. RHONDA E. LAW PT

Table of content: USHA PRADHAN (NPI 1275325235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093767832 NPI number — MRS. RHONDA E. LAW PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAW
Provider First Name:
RHONDA
Provider Middle Name:
E.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARLSON
Provider Other First Name:
RHONDA
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093767832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 LAKE HELENA ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-895-4017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 POTTERY AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-895-9090
Provider Business Practice Location Address Fax Number:
360-895-9089
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00003991 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8339350 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912075994 . This is a "KETSAP PHYSICAL THEREP SP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0159012 . This is a "L I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00129558 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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