Healthcare Provider Details

I. General information

NPI: 1609128453
Provider Name (Legal Business Name): MYRA J KURTZ PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRA GUDEMAN PT

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S 23RD ST STE 210
TACOMA WA
98405-1605
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-8684
  • Fax: 253-284-0450
Mailing address:
  • Phone: 630-296-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT00009756
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: