Provider Demographics
NPI:1073600474
Name:JANET L ANSPACH RICKEY
Entity Type:Organization
Organization Name:JANET L ANSPACH RICKEY
Other - Org Name:JANET ANSPACH RICKEY PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSPACH-RICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-638-1680
Mailing Address - Street 1:8202 NE STATE HIGHWAY 104 STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9454
Mailing Address - Country:US
Mailing Address - Phone:360-638-1680
Mailing Address - Fax:360-638-0299
Practice Address - Street 1:30996 OLD HANSVILLE RD NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9618
Practice Address - Country:US
Practice Address - Phone:360-638-1680
Practice Address - Fax:360-638-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7094683Medicaid
WA7094683Medicaid
WAG8806731Medicare PIN