Basic Information
Provider Information
NPI: 1194963835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAND
FirstName: ROBBIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HAND
OtherFirstName: ROB
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 5
Mailing Information
Address1: PO BOX 5299
Address2: MAIL STOP 710-1-PHYS
City: TACOMA
State: WA
PostalCode: 984150299
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 315 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984054234
CountryCode: US
TelephoneNumber: 2534031000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/03/2009
LastUpdateDate: 02/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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