Benjamin Michael Radack, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7373 Issued in AZ

Practice address

19319 7TH Ave NE
#108
Poulsbo, WA 98370-7442

Phone

(360) 779-3777

Fax

(360) 779-3797

NPI assigned

Jul 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1235441197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19319 7TH AVE NE",
            "address_2": "#108",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707442",
            "telephone_number": "360-779-3777",
            "fax_number": "360-779-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19319 7TH AVE NE",
            "address_2": "#108",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707442",
            "telephone_number": "360-779-3777",
            "fax_number": "360-779-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADACK",
        "first_name": "BENJAMIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "7373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Kevin Pulver, DDS
• Quantum Leap Physical Therapy
• Amanda Qvigstad
• R Scott Puhn DDS PS
• R.S. Puhn, D.D.S., P.L.L.C.
• Scott Radetski, LMHCA, M-DIV
• Jamie P Radner, LIC. AC.
• Rachel Ramey
• Robert E Randolph, M.D.
• Carol Ann Rappaport, MD

• Physical Therapist in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.