=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316487457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAELA ANNE PAULY PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2017
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10564 5TH AVE NE STE 405
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-672-0145
-----------------------------------------------------
Fax | 855-564-1831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10564 5TH AVE NE STE 405
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-672-0145
-----------------------------------------------------
Fax | 855-564-1831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTL.0014255
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 117153
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT60728384
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------