Healthcare Provider Details

I. General information

NPI: 1669589503
Provider Name (Legal Business Name): RUTH KNAGENHJELM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22659 PACIFIC HWY S
DES MOINES WA
98198-5155
US

IV. Provider business mailing address

181 S 333RD ST STE 250
FEDERAL WAY WA
98003-7363
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-3668
  • Fax: 206-824-3964
Mailing address:
  • Phone: 253-874-2998
  • Fax: 253-874-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: