Provider Demographics
NPI: | 1437130770 |
---|---|
Name: | RADONICH, BARBARA ANN (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | BARBARA |
Middle Name: | ANN |
Last Name: | RADONICH |
Suffix: | |
Gender: | F |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | BARBARA |
Other - Middle Name: | ANN |
Other - Last Name: | PILEWSKI |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PT |
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: | |
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 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-11-11 |
Last Update Date: | 2012-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | PT00000677 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 7041437 | Medicaid | |
WA | R11874 | Medicare UPIN | |
WA | G001061601 | Medicare PIN |