Provider Demographics
NPI:1891010625
Name:RIECKELMAN, PARKER EDWARD (PTA)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:EDWARD
Last Name:RIECKELMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 220TH ST SW
Mailing Address - Street 2:STE #1
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2166
Mailing Address - Country:US
Mailing Address - Phone:425-775-7274
Mailing Address - Fax:
Practice Address - Street 1:6601 220TH ST SW
Practice Address - Street 2:STE #1
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2166
Practice Address - Country:US
Practice Address - Phone:425-775-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60126268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant