Provider Demographics
NPI:1629066717
Name:HARADA PHYSICAL THERAPY & REHAB SERVICES INC., P.S.
Entity Type:Organization
Organization Name:HARADA PHYSICAL THERAPY & REHAB SERVICES INC., P.S.
Other - Org Name:HARADA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-679-8600
Mailing Address - Street 1:31955 STATE ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5211
Mailing Address - Country:US
Mailing Address - Phone:360-679-8600
Mailing Address - Fax:360-679-8554
Practice Address - Street 1:31955 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5211
Practice Address - Country:US
Practice Address - Phone:360-679-8600
Practice Address - Fax:360-679-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36955Medicare ID - Type UnspecifiedMEDICARE