MEDICARE: THE KEGEL COMMUNITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1346946407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KEGEL COMMUNITY

Provider Business Mailing Address
First Line	:	103 MAIN AVE S STE 208
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8197
Country	:	US
Telephone Number	:	425-270-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 MAIN AVE S STE 208
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8197
Country	:	US
Telephone Number	:	425-270-7099
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. KAELI CHRISTINE GOCKEL
Credential	:	DPT
Telephone Number	:	425-270-7099

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “THE KEGEL COMMUNITY ” Practice Location

Language	Start Address	Practice Location

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