Individual provider Active NPI

Reshma Kamburath Radhakrishnan, DPT

  • Physical Therapist
  • Seattle, WA
National Provider Identifier
1023862455
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT61417905 Issued in WA
Practice address
1815 N 45TH St Ste 202
Seattle, WA 98103-6856
Phone
(206) 752-6837
Fax
(206) 701-3398
NPI assigned
Apr 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT61417905 WA Primary

Addresses

Primary practice location

1815 N 45TH St Ste 202
Seattle, WA 98103-6856

Mailing address

4220 132ND St SE Ste 101
Mill Creek, WA 98012-8999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT61417905WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince May 6, 2024 Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince May 6, 2024 Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist Current Accepting new patients

Locations

10207 19th Ave SE
Everett, WA 98208
Phone (425) 337-3166

403 W Stanley St
Granite Falls, WA 98252
Phone (360) 691-4835

4220 132nd St SE
Ste 101
Mill Creek, WA 98012
Phone (425) 316-8046

1815 N 45th St
Ste 202
Seattle, WA 98103
Phone (206) 752-6837

201 W North River Dr
Ste 510
Spokane, WA 99201
Phone (509) 323-0066

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1023862455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 132ND ST SE STE 101",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980128999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 N 45TH ST STE 202",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036856",
            "telephone_number": "206-752-6837",
            "fax_number": "206-701-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMBURATH RADHAKRISHNAN",
        "first_name": "RESHMA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-12",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61417905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.