Healthcare Provider Details

I. General information

NPI: 1760315295
Provider Name (Legal Business Name): KAYATHRIDEVI KRISHNASAMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NW GILMAN BLVD STE 200
ISSAQUAH WA
98027-2470
US

IV. Provider business mailing address

2000 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1055
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-6804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.60337161
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: