Basic Information
| Provider Information | |||||||||
| NPI: | 1013029685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONAGH | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | ROBERTS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ROBERTS | ||||||||
| OtherFirstName: | VIRGINIA | ||||||||
| OtherMiddleName: | DIANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 181 S 333RD ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980037363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538742998 | ||||||||
| FaxNumber: | 2538743307 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 42ND AVE SW | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069331030 | ||||||||
| FaxNumber: | 2069331032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6342 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.