Provider Demographics
NPI:1164554614
Name:PRANDI, ROBERT (MSPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PRANDI
Suffix:
Gender:M
Credentials:MSPT
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 383
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98556-0383
Mailing Address - Country:US
Mailing Address - Phone:360-330-9346
Mailing Address - Fax:360-330-9347
Practice Address - Street 1:2700 COLONIAL DR APT 305
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8858
Practice Address - Country:US
Practice Address - Phone:360-330-9346
Practice Address - Fax:360-330-9347
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8870537Medicare PIN