Healthcare Provider Details

I. General information

NPI: 1003069725
Provider Name (Legal Business Name): RYAN PATRICK HASKELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2008
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 174TH ST NE
MARYSVILLE WA
98271-4743
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 360-454-1945
  • Fax: 360-454-1991
Mailing address:
  • Phone: 360-454-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: