MEDICARE: HEIDI KODESKI PT

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	225100000X	Physical Therapist	PT8731	WA

General Provider Information

NPI Number	:	1225102700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI KODESKI PT

Provider Business Mailing Address
First Line	:	1601 116TH AVE NE
Second Line	:	SUITE 101
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3010
Country	:	US
Telephone Number	:	425-881-3100
Fax Number	:	425-881-3102

Provider Business Practice Location Address
First Line	:	1601 116TH AVE NE
Second Line	:	SUITE 101
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3010
Country	:	US
Telephone Number	:	425-881-3100
Fax Number	:	425-881-3102

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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Directions to “ HEIDI KODESKI PT” Practice Location

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