MEDICARE: KELVIN CALAMIONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	61273194	WA

General Provider Information

NPI Number	:	1033869979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN CALAMIONG

Provider Business Mailing Address
First Line	:	13649 26TH PL S
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98168-3807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 S 336TH ST STE 112
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-7355
Country	:	US
Telephone Number	:	253-661-0041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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