Healthcare Provider Details

I. General information

NPI: 1750726659
Provider Name (Legal Business Name): KAREN MARIE KWASNY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CEDAR ST B-1
TACOMA WA
98405-2308
US

IV. Provider business mailing address

4220 132ND ST SE SUITE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-6910
  • Fax: 253-383-4218
Mailing address:
  • Phone: 425-316-8046
  • Fax: 425-338-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4078
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: