MEDICARE: VIRGINIA ROBERTS MCDONAGH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6342	WA

General Provider Information

NPI Number	:	1013029685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA ROBERTS MCDONAGH PT

Provider Business Mailing Address
First Line	:	181 S 333RD ST STE 250
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-7363
Country	:	US
Telephone Number	:	253-874-2998
Fax Number	:	253-874-3307

Provider Business Practice Location Address
First Line	:	4700 42ND AVE SW
Second Line	:	SUITE 510
City	:	SEATTLE
State	:	WA
Zip	:	98116-4591
Country	:	US
Telephone Number	:	206-933-1030
Fax Number	:	206-933-1032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/22/2014

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