Healthcare Provider Details

I. General information

NPI: 1699343582
Provider Name (Legal Business Name): KAYLEE CAITLIN VINSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38110 236TH AVE SE
ENUMCLAW WA
98022-5802
US

IV. Provider business mailing address

38110 236TH AVE SE
ENUMCLAW WA
98022-5802
US

V. Phone/Fax

Practice location:
  • Phone: 425-358-1587
  • Fax:
Mailing address:
  • Phone: 425-358-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61152271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: