Provider Demographics
NPI:1487645891
Name:ENYEART, RONALD DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DEAN
Last Name:ENYEART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25923 SE 40TH CT
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7767
Mailing Address - Country:US
Mailing Address - Phone:425-391-4488
Mailing Address - Fax:425-391-8287
Practice Address - Street 1:2850 228TH AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9301
Practice Address - Country:US
Practice Address - Phone:425-391-4488
Practice Address - Fax:425-391-8287
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB18247Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER