Provider Demographics
NPI:1073823696
Name:DELA PAZ, IRISH PEDIANGCO (PT)
Entity type:Individual
Prefix:MRS
First Name:IRISH
Middle Name:PEDIANGCO
Last Name:DELA PAZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:IRISH
Other - Middle Name:QUILINO
Other - Last Name:PEDIANGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 S 224TH ST APT E301
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8835
Mailing Address - Country:US
Mailing Address - Phone:206-302-9109
Mailing Address - Fax:
Practice Address - Street 1:2800 S 224TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5132
Practice Address - Country:US
Practice Address - Phone:206-824-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60151196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist