Provider Demographics
NPI:1639111560
Name:O'CONNOR, RHEA (PT)
Entity type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:O'CONNOR
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 1:10207 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4257
Mailing Address - Country:US
Mailing Address - Phone:425-337-3166
Mailing Address - Fax:425-338-4596
Practice Address - Street 1:10207 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4257
Practice Address - Country:US
Practice Address - Phone:425-337-3166
Practice Address - Fax:425-338-4596
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0112780OtherLABOR & INDUSTRY
WA1020OCOtherREGENCE RIDER #
WA911745305-98208-A010OtherTRICARE
WA7083322Medicaid
WA0130583OtherLABOR & INDUSTRY
WA0130583OtherLABOR & INDUSTRY