Provider Demographics
NPI:1215983465
Name:RICE, BECKY SUZANNE (MS, PT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:SUZANNE
Last Name:RICE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:SUZANNE
Other - Last Name:LEAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-9768
Mailing Address - Fax:360-629-7528
Practice Address - Street 1:27500 102ND AVE NW
Practice Address - Street 2:STE 1
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8092
Practice Address - Country:US
Practice Address - Phone:360-629-9768
Practice Address - Fax:360-629-6487
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8870780Medicare PIN
WAGAB34027Medicare PIN