Healthcare Provider Details

I. General information

NPI: 1801421573
Provider Name (Legal Business Name): RAILEY NADINE HANSEN-KEITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 AVENUE D
SNOHOMISH WA
98290-2744
US

IV. Provider business mailing address

1308 80TH AVE SE
LAKE STEVENS WA
98258-7324
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-1020
  • Fax:
Mailing address:
  • Phone: 425-345-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number61028650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: