Healthcare Provider Details

I. General information

NPI: 1144778689
Provider Name (Legal Business Name): KAITLYN ELIZABETH LANTZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN WILSON

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17650 140TH AVE SE STE B7
RENTON WA
98058-6814
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 425-430-0700
  • Fax: 425-430-0710
Mailing address:
  • Phone: 866-370-8206
  • Fax: 517-435-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.022517
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60756736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: