Provider Demographics
NPI:1235358854
Name:SHIOSAKI, ROLANDA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:LYNN
Last Name:SHIOSAKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROLANDA
Other - Middle Name:LYNN
Other - Last Name:KREBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-1509
Mailing Address - Country:US
Mailing Address - Phone:206-408-7398
Mailing Address - Fax:206-259-3107
Practice Address - Street 1:19001 VASHON HWY SW STE 108
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5214
Practice Address - Country:US
Practice Address - Phone:206-408-7398
Practice Address - Fax:206-259-3107
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005720Medicaid
WA8340226Medicaid