Healthcare Provider Details

I. General information

NPI: 1225776743
Provider Name (Legal Business Name): KASIH DENEB TATUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 NE 12TH ST STE 3A
BELLEVUE WA
98005-2461
US

IV. Provider business mailing address

17020 TWIN LAKES AVE STE C101
MARYSVILLE WA
98271-4731
US

V. Phone/Fax

Practice location:
  • Phone: 360-658-8400
  • Fax: 360-658-2606
Mailing address:
  • Phone: 396-065-8840
  • Fax: 360-658-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61178441
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: