Healthcare Provider Details

I. General information

NPI: 1285740449
Provider Name (Legal Business Name): KEVIN R PIASECKI MSPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 220TH ST SW STE 303
MOUNTLAKE TERRACE WA
98043-2187
US

IV. Provider business mailing address

6808 220TH ST SW STE 303
MOUNTLAKE TERRACE WA
98043-2187
US

V. Phone/Fax

Practice location:
  • Phone: 425-650-1900
  • Fax: 425-650-1970
Mailing address:
  • Phone: 425-650-1900
  • Fax: 425-650-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00008038
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: