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General NPI Number Information
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NPI Number | 1568721504
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Entity Type | Individual
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Provider Name | KEZIA G NAILLIEUX-JOHNSON PT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 2201 NE 65TH ST
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City | SEATTLE
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State | WA
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Zip | 98115-7020
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Country | US
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Telephone | 206-535-7356
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Fax | 206-466-1527
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Provider Business Mailing Address
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Address Line | 3603 S MCCLELLAN ST
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City | SEATTLE
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State | WA
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Zip | 98144-5615
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Country | US
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Telephone | 206-535-7356
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Fax | 206-466-1527
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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 | 05010829A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60585779
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License Number State | WA
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