Provider Demographics
NPI:1952961419
Name:REDHEAD REHAB PLLC
Entity Type:Organization
Organization Name:REDHEAD REHAB PLLC
Other - Org Name:REDHEAD PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MAURA
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:360-474-3192
Mailing Address - Street 1:7215 116TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1102
Mailing Address - Country:US
Mailing Address - Phone:360-474-3192
Mailing Address - Fax:425-278-0628
Practice Address - Street 1:7215 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1102
Practice Address - Country:US
Practice Address - Phone:360-474-3192
Practice Address - Fax:425-278-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty