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NPI Code Detail

MEDICARE: LARYSSA NICOLE MATHENY PT

MEDICARE: LARYSSA NICOLE MATHENY PT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1912375106
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARYSSA NICOLE MATHENY PT
Provider Business Mailing Address
First Line : 22415 68TH AVE S
Second Line :
City : KENT
State : WA
Zip : 98032-2444
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22415 68TH AVE S
Second Line :
City : KENT
State : WA
Zip : 98032-2444
Country : US
Telephone Number : 253-395-1131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2015
Last Update Date : 01/26/2026

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Directions to “ LARYSSA NICOLE MATHENY PT” Practice Location

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