Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60467500 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT60467500 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT60467500 | WA |
NPI | 1326443227 |
---|---|
Provider Name | Matthew Didonato |
First Address | Lacey, WA 98516-6608 |
Second Address | Lacey, WA 98516-6608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT60467500 | STATE LICENSE (01) | WA |