Healthcare Provider Details

I. General information

NPI: 1609951417
Provider Name (Legal Business Name): AARON K KINGSLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 MONTLAKE BLVD NE RM 148 B ARENA/HEC EDMUNDSON PAVILLION
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

3805 FREMONT AVE N APT 304
SEATTLE WA
98103-8766
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-1552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009490
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: