Healthcare Provider Details

I. General information

NPI: 1598300824
Provider Name (Legal Business Name): KINTSUGI PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17833 1ST AVE S STE A
NORMANDY PARK WA
98148-1713
US

IV. Provider business mailing address

1940 S BONITO WAY STE 190
MERIDIAN ID
83642-5618
US

V. Phone/Fax

Practice location:
  • Phone: 253-330-8518
  • Fax: 253-330-8519
Mailing address:
  • Phone: 208-287-9420
  • Fax: 208-287-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY RILEY
Title or Position: OWNER/PT
Credential: DPT
Phone: 253-330-8518