Provider Demographics
NPI:1326062191
Name:MCRAE AND RADONICH INC PS
Entity Type:Organization
Organization Name:MCRAE AND RADONICH INC PS
Other - Org Name:PHYSICAL THERAPY ASSOCIATES INC PS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-565-3551
Mailing Address - Street 1:4606 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4200
Mailing Address - Country:US
Mailing Address - Phone:253-565-3551
Mailing Address - Fax:253-565-4535
Practice Address - Street 1:4606 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4200
Practice Address - Country:US
Practice Address - Phone:253-565-3551
Practice Address - Fax:253-565-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001061600Medicare PIN