Provider Demographics
NPI:1942441209
Name:ADRIATICO, JON (PT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:ADRIATICO
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 1:80 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5937
Mailing Address - Country:US
Mailing Address - Phone:425-226-4610
Mailing Address - Fax:425-235-4758
Practice Address - Street 1:80 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5937
Practice Address - Country:US
Practice Address - Phone:425-226-4610
Practice Address - Fax:425-235-4758
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist