Provider Demographics
NPI:1417238122
Name:RIDGEFIELD PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:RIDGEFIELD PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSKINIEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-887-7147
Mailing Address - Street 1:2 S 56TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3425
Mailing Address - Country:US
Mailing Address - Phone:360-887-7147
Mailing Address - Fax:360-887-7148
Practice Address - Street 1:2 S 56TH PL
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3425
Practice Address - Country:US
Practice Address - Phone:360-887-7147
Practice Address - Fax:360-887-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy