Provider Demographics
NPI:1003069725
Name:HASKELL, RYAN PATRICK
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:HASKELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-454-1945
Mailing Address - Fax:
Practice Address - Street 1:2901 174TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4743
Practice Address - Country:US
Practice Address - Phone:360-454-1945
Practice Address - Fax:360-454-1991
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5311HAOtherREGENCE
WA8949261OtherL&I CRIME VICTIMS
WA0242005OtherL&I
WA5307HAOtherREGENCE
WA8951177OtherL&I CRIME VICTIMS
WA0248638OtherL&I
WA5309HAOtherREGENCE
WA5308HAOtherREGENCE
WA5305HAOtherREGENCE
WA8402620OtherDSHS
WAG8876724Medicare PIN
WA8951177OtherL&I CRIME VICTIMS