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General NPI Number Information
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NPI Number | 1053678474
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Entity Type | Individual
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Provider Name | KEANE A. K KUAPAHI PTA
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 3850 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-3701
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Country | US
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Telephone | 253-845-9098
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 N PROSPECT ST
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City | TACOMA
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State | WA
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Zip | 98406-8011
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Country | US
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Telephone | 808-258-5449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P16000029289
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License Number State | WA
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