Healthcare Provider Details

I. General information

NPI: 1548000698
Provider Name (Legal Business Name): CEILI MONIQUE YSABEL KACMARCIK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE STE F120
KIRKLAND WA
98034-3025
US

IV. Provider business mailing address

18420 102ND AVE NE APT 223
BOTHELL WA
98011-3524
US

V. Phone/Fax

Practice location:
  • Phone: 425-305-2940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: