Provider Demographics
NPI:1598729642
Name:PRITCHARD, MANDY M (MPT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:M
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:M
Other - Last Name:MOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:17650 140TH AVE SE
Practice Address - Street 2:#B-07
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-6814
Practice Address - Country:US
Practice Address - Phone:425-430-0700
Practice Address - Fax:425-430-0710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5224MOOtherREGENCE BLUE SHIELD
WA8337123Medicaid
WA169771OtherDEPT OF LABOR & INDUSTRIE
WA8934739OtherCRIME VICTIMS
WAP00014671OtherRAILROAD MEDICARE
WAAB36732Medicare ID - Type UnspecifiedKING COUNTY
WA8934739OtherCRIME VICTIMS