1720259450 NPI number — REDMOND RIDGE PHYSICAL THERAPY PLLC

Table of content: (NPI 1720259450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720259450 NPI number — REDMOND RIDGE PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDMOND RIDGE PHYSICAL THERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720259450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22500 NE MARKETPLACE DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98053-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-836-1034
Provider Business Mailing Address Fax Number:
425-836-1037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22500 NE MARKETPLACE DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98053-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-836-1034
Provider Business Practice Location Address Fax Number:
425-836-1037
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BINSTEIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-297-7000

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7141922 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9249165 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DH1213 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0232273 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 613292200 . This is a "OWCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8946931 . This is a "L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8872140 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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