Provider Demographics
NPI:1356491658
Name:RIVARD, JAMES RONALD
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RONALD
Last Name:RIVARD
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 1:1540 140TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4516
Mailing Address - Country:US
Mailing Address - Phone:425-644-6048
Mailing Address - Fax:425-641-2721
Practice Address - Street 1:1540 140TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4516
Practice Address - Country:US
Practice Address - Phone:425-644-6048
Practice Address - Fax:425-641-2721
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARI8243OtherREGENCE BLUE SHIELD OF WA
WA0127989OtherLABOR AND INDUSTRIES
WAAB09943Medicare ID - Type Unspecified