Provider Demographics
NPI:1558300194
Name:HARADA, GREG A (DPT)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:A
Last Name:HARADA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:9514 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1514
Practice Address - Country:US
Practice Address - Phone:253-983-9395
Practice Address - Fax:253-983-9411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8339335Medicaid
WA142194OtherLABOR & INDUSTRIES
WA8017HAOtherREGENCE BLUESHIELD
WA8901913OtherL&I CRIME VICTIMS PRGM
WA8017HAOtherREGENCE BLUESHIELD
WAP00235951Medicare ID - Type UnspecifiedRAILROAD MEDICARE