Healthcare Provider Details

I. General information

NPI: 1376891044
Provider Name (Legal Business Name): KRISTEN MICHELLE GIANNARIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 NE 204TH ST
BOTHELL WA
98011-2447
US

IV. Provider business mailing address

10005 NE 204TH ST
BOTHELL WA
98011-2447
US

V. Phone/Fax

Practice location:
  • Phone: 925-787-2664
  • Fax:
Mailing address:
  • Phone: 925-787-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39188
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: