Healthcare Provider Details

I. General information

NPI: 1043793698
Provider Name (Legal Business Name): KATHERINE BOISSERANC DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 AVENUE D
SNOHOMISH WA
98290-2744
US

IV. Provider business mailing address

12121 46TH DR SE
EVERETT WA
98208-9653
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-1020
  • Fax:
Mailing address:
  • Phone: 425-361-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60845228
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: