Provider Demographics
NPI:1225049844
Name:SHIRINZADEH, RAFAT (MPT)
Entity Type:Individual
Prefix:MR
First Name:RAFAT
Middle Name:
Last Name:SHIRINZADEH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 CONVENTION PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:509-545-1010
Mailing Address - Fax:509-545-1112
Practice Address - Street 1:4215 CONVENTION PL
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-545-1010
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151973OtherLABOR & INDUSTRIES
WA7108806Medicaid
WAP44275Medicare UPIN
WAGAB25316Medicare ID - Type Unspecified
WA7108806Medicaid