Provider Demographics
NPI:1013029685
Name:MCDONAGH, VIRGINIA ROBERTS (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROBERTS
Last Name:MCDONAGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:DIANE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 S 333RD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7363
Mailing Address - Country:US
Mailing Address - Phone:253-874-2998
Mailing Address - Fax:253-874-3307
Practice Address - Street 1:4700 42ND AVE SW
Practice Address - Street 2:SUITE 510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4591
Practice Address - Country:US
Practice Address - Phone:206-933-1030
Practice Address - Fax:206-933-1032
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist