Healthcare Provider Details

I. General information

NPI: 1679435093
Provider Name (Legal Business Name): KRISTINE RENAE KINGSBURY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 1ST AVE NE STE 5
DUVALL WA
98019-5005
US

IV. Provider business mailing address

PO BOX 431
DUVALL WA
98019-0431
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 425-788-0505
  • Fax: 425-788-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70049189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: