Healthcare Provider Details

I. General information

NPI: 1619424892
Provider Name (Legal Business Name): KALYN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

2200 THORNDYKE AVE W #210
SEATTLE WA
98199-3500
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-2506
  • Fax: 206-744-2642
Mailing address:
  • Phone: 360-990-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160658345
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: