Provider Demographics
NPI:1215298252
Name:PADERNAL, CHARLOTTE MARILLA (PT)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARILLA
Last Name:PADERNAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:MARILLA
Other - Last Name:PADERNAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6408 PENROSE POINT DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8037
Mailing Address - Country:US
Mailing Address - Phone:509-987-4949
Mailing Address - Fax:
Practice Address - Street 1:6408 PENROSE POINT DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8037
Practice Address - Country:US
Practice Address - Phone:509-987-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist