Healthcare Provider Details

I. General information

NPI: 1326809435
Provider Name (Legal Business Name): KYLE CRAWFORD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15932 REDMOND WAY STE 102
REDMOND WA
98052-4060
US

IV. Provider business mailing address

209 KIRKLAND AVE
KIRKLAND WA
98033-6503
US

V. Phone/Fax

Practice location:
  • Phone: 425-636-8369
  • Fax: 425-636-8517
Mailing address:
  • Phone: 425-629-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61487047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: