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NPI Code Detail

MEDICARE: GREG A HARADA DPT

MEDICARE: GREG A HARADA DPT
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
1225100000XPhysical TherapistPT00008931WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2142194OTHERWALABOR & INDUSTRIES
38017HAOTHERWAREGENCE BLUESHIELD
48901913OTHERWAL&I CRIME VICTIMS PRGM

General Provider Information

NPI Number : 1558300194
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREG A HARADA DPT
Provider Business Mailing Address
First Line : 9315 GRAVELLY LAKE DR SW
Second Line : SUITE 203
City : LAKEWOOD
State : WA
Zip : 98499-1574
Country : US
Telephone Number : 253-581-5200
Fax Number : 253-581-5203
Provider Business Practice Location Address
First Line : 9514 GRAVELLY LAKE DR SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-1514
Country : US
Telephone Number : 253-983-9395
Fax Number : 253-983-9411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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Directions to “ GREG A HARADA DPT” Practice Location

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