Provider Demographics
NPI:1962643965
Name:REDMOND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:REDMOND PHYSICAL THERAPY, INC.
Other - Org Name:PREMIER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRINKLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, OCS
Authorized Official - Phone:425-881-3001
Mailing Address - Street 1:16261 REDMOND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3833
Mailing Address - Country:US
Mailing Address - Phone:425-881-3001
Mailing Address - Fax:425-881-3585
Practice Address - Street 1:16261 REDMOND WAY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3833
Practice Address - Country:US
Practice Address - Phone:425-881-3001
Practice Address - Fax:425-881-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy