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General NPI Number Information
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NPI Number | 1104460153
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Entity Type | Individual
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Provider Name | KEARSTEN ELIZABETH SEGO
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Gender | Female
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Dates
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Enumeration Date | 11/03/2019
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-2717
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Country | US
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Telephone | 253-968-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 91-1018 WAIILIKAHI ST
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City | EWA BEACH
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State | HI
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Zip | 96706-6406
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Country | US
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Telephone | 808-352-1939
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60994055
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License Number State | WA
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