Healthcare Provider Details

I. General information

NPI: 1649928672
Provider Name (Legal Business Name): KAYLEE MARIE MARCINKO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MONTE VILLA PKWY
BOTHELL WA
98021-8972
US

IV. Provider business mailing address

9011 NE 133RD PL
KIRKLAND WA
98034-1871
US

V. Phone/Fax

Practice location:
  • Phone: 425-408-7604
  • Fax:
Mailing address:
  • Phone: 425-351-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12733171-2401
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61268105
License Number StateWA

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: