Provider Demographics
NPI:1750635173
Name:BOND, RENAE DIANE (PT)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:DIANE
Last Name:BOND
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 1:1113 LEGION WAY SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1652
Mailing Address - Country:US
Mailing Address - Phone:360-596-6111
Mailing Address - Fax:
Practice Address - Street 1:1113 LEGION WAY SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1652
Practice Address - Country:US
Practice Address - Phone:360-596-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist