Provider Demographics
NPI:1558932343
Name:MADICH, HUNTER PARK (DPT)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:PARK
Last Name:MADICH
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 1:15446 BEL RED RD STE B20
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5526
Mailing Address - Country:US
Mailing Address - Phone:425-869-2777
Mailing Address - Fax:425-869-0167
Practice Address - Street 1:15446 BEL RED RD STE B20
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5526
Practice Address - Country:US
Practice Address - Phone:425-869-2777
Practice Address - Fax:425-869-0167
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0695187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist