Healthcare Provider Details

I. General information

NPI: 1174487896
Provider Name (Legal Business Name): REBELLE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 1ST AVE N UNIT B10
SEATTLE WA
98109-2301
US

IV. Provider business mailing address

2120 1ST AVE N UNIT B10
SEATTLE WA
98109-2301
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-8115
  • Fax:
Mailing address:
  • Phone: 206-414-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE IDA KARDOS
Title or Position: OWNER
Credential: DACHM, LAC, LMT
Phone: 206-687-5727