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General NPI Number Information
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NPI Number | 1598122517
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Entity Type | Individual
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Provider Name | PHYLLIS JOANN KISER
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Gender | Female
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 124 BELLEVUE AVE E UNIT 504
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City | SEATTLE
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State | WA
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Zip | 98102-5599
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Country | US
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Telephone | 615-497-2177
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Fax |
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Provider Business Mailing Address
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Address Line | 7006 MASONBORO DR
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City | SPRING HILL
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State | TN
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Zip | 37174-6239
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Country | US
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Telephone |
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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 | 42979
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License Number State | CA
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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 | 10021
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60632555
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License Number State | WA
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