Provider Demographics
NPI:1689715757
Name:FANKHAUSER, ROBERT K (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:FANKHAUSER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:9514 4TH ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-2327
Practice Address - Fax:425-377-0283
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00002036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340150Medicaid
WAAB14909Medicare ID - Type Unspecified