Basic Information
| Provider Information | |||||||||
| NPI: | 1649570508 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RC REHAB, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | APPLE PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2170 | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983900480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532862413 | ||||||||
| FaxNumber: | 2538406340 | ||||||||
| Practice Location | |||||||||
| Address1: | 2904 4TH AVE NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983727053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532862413 | ||||||||
| FaxNumber: | 2538406340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | CIANCIO | ||||||||
| AuthorizedOfficialFirstName: | CLAUDE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | COO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2532862413 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.