Provider Demographics
NPI:1033148010
Name:BOLTON, RESA (PT)
Entity type:Individual
Prefix:
First Name:RESA
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24060 SE KENT KANGLEY RD STE D100
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6851
Mailing Address - Country:US
Mailing Address - Phone:425-690-3522
Mailing Address - Fax:425-690-9522
Practice Address - Street 1:24060 SE KENT KANGLEY RD STE D100
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6851
Practice Address - Country:US
Practice Address - Phone:425-690-3522
Practice Address - Fax:425-690-9522
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000793Medicaid
WA7031578Medicaid