Provider Demographics
NPI:1063610616
Name:RICKENBACHER-TRUNK, CONSTANCE MARY (PT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARY
Last Name:RICKENBACHER-TRUNK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:MARY
Other - Last Name:TRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:235-459-6999
Mailing Address - Fax:253-459-6980
Practice Address - Street 1:3209 S 23RD ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:235-459-6999
Practice Address - Fax:253-459-6980
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist