Provider Demographics
NPI:1710955786
Name:MARES, RADKA (PT)
Entity Type:Individual
Prefix:MS
First Name:RADKA
Middle Name:
Last Name:MARES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 102ND AVE SE
Mailing Address - Street 2:110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6131
Mailing Address - Country:US
Mailing Address - Phone:609-216-3484
Mailing Address - Fax:
Practice Address - Street 1:7 DUNMORE AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1937
Practice Address - Country:US
Practice Address - Phone:609-396-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00547700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist