Provider Demographics
NPI:1376902445
Name:RANTUNG, DONALD (PTA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:RANTUNG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 176TH ST SW
Mailing Address - Street 2:APT S1
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3497
Mailing Address - Country:US
Mailing Address - Phone:425-772-0853
Mailing Address - Fax:
Practice Address - Street 1:4722 176TH ST SW
Practice Address - Street 2:APT S1
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3497
Practice Address - Country:US
Practice Address - Phone:425-772-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160623783225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant