1538541750 NPI number — REDMOND RIDGE PHYSICAL THERAPY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538541750 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:
6
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:
1538541750
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:
13930 NE 178TH PL STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODINVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98072-3571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-939-2194
Provider Business Mailing Address Fax Number:
425-318-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13930 NE 178TH PL
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-3571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-939-2194
Provider Business Practice Location Address Fax Number:
425-318-1102
Provider Enumeration Date:
06/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BISNTEIN
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: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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