Provider Demographics
NPI:1164571469
Name:SCHADE, ZACHARY J
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:SCHADE
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 1:5210 CORPORATE CENTER LOOP SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5952
Mailing Address - Country:US
Mailing Address - Phone:360-455-8155
Mailing Address - Fax:360-455-1655
Practice Address - Street 1:111 MARKET ST NE
Practice Address - Street 2:SUITE 108
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1008
Practice Address - Country:US
Practice Address - Phone:360-754-7085
Practice Address - Fax:360-754-3671
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA710883456-98516-A004OtherTRICARE
WA8834SCOtherREGENCE BS
WA3536SCOtherREGENCE BS
WA4613525OtherAETNA
WA710883456-98502-A006OtherTRICARE
WA710883456-98503-A008OtherTRICARE
WA710883456-98501-A009OtherTRICARE
WA5193SCOtherREGENCE BS
WA7456SCOtherREGENCE BS
WA8340762Medicaid
WA8943978OtherL&I CRIME VICTIMS
WA3336SCOtherREGENCE BS
WA710883456-98512-A007OtherTRICARE
WA0218904OtherDEPT OF L&I
WA4613525OtherAETNA