Provider Demographics
NPI:1417955147
Name:ANSPACH-RICKEY, JANET LOUISE (PT DIPMDT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:ANSPACH-RICKEY
Suffix:
Gender:F
Credentials:PT DIPMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30996 OLD HANSVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9618
Mailing Address - Country:US
Mailing Address - Phone:360-638-1680
Mailing Address - Fax:360-638-0299
Practice Address - Street 1:8202 NE STATE HIGHWAY 104
Practice Address - Street 2:SUITE 102, #40
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-638-1680
Practice Address - Fax:360-638-0299
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003484225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8383861Medicaid
WAS74733Medicare UPIN
WAG8806733Medicare PIN