Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00002941 | WA |
NPI | 1003025701 |
---|---|
Provider Name | Kay Wieben |
First Address | Lynnwood, WA 98087-6305 |
Second Address | Bellevue, WA 98004-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |