Provider Demographics
NPI:1033308499
Name:MCNAMARA, RONALD JAMES (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 MERIDIAN E STE 100
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-2414
Mailing Address - Country:US
Mailing Address - Phone:253-770-1807
Mailing Address - Fax:253-770-1985
Practice Address - Street 1:14207 MERIDIAN E STE 100
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-2414
Practice Address - Country:US
Practice Address - Phone:253-770-1807
Practice Address - Fax:253-770-1985
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00009950OtherPT LICENSE