Healthcare Provider Details

I. General information

NPI: 1871556886
Provider Name (Legal Business Name): KIMBERLY D BENNETT PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E OLIVE ST STE B
SEATTLE WA
98122-8406
US

IV. Provider business mailing address

PO BOX 759
MERCER ISLAND WA
98040-0759
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-0710
  • Fax: 206-322-9169
Mailing address:
  • Phone: 206-778-6405
  • Fax: 206-322-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number00002906
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00002906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: