MEDICARE: MS. KATHLEEN ANN KERKOF P.T.

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	225100000X	Physical Therapist	PT00002863	WA

General Provider Information

NPI Number	:	1740490689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN KERKOF P.T.

Provider Business Mailing Address
First Line	:	2235 NW 64TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2442
Country	:	US
Telephone Number	:	206-782-4528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 NW 64TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2442
Country	:	US
Telephone Number	:	206-782-4528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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