Provider Demographics
NPI:1134311525
Name:PARHAM, DESIREE R (PT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:R
Last Name:PARHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 164TH AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-658-4980
Mailing Address - Fax:425-658-4977
Practice Address - Street 1:8630 164TH AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:425-658-4977
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8874203Medicare PIN
WAG8905378Medicare PIN
WAG8869869Medicare PIN