Provider Demographics
NPI:1629152442
Name:ZINN, WADE RANDALL (PT,)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:RANDALL
Last Name:ZINN
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 1:19611 7TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7384
Mailing Address - Country:US
Mailing Address - Phone:360-697-7710
Mailing Address - Fax:360-779-3829
Practice Address - Street 1:19611 7TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7384
Practice Address - Country:US
Practice Address - Phone:360-697-7710
Practice Address - Fax:360-779-3829
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7074917Medicaid
WA8346520Medicaid
WAAB 01532Medicare ID - Type Unspecified