Provider Demographics
NPI:1063565620
Name:VAN DINTER, KRISTEN S (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:S
Last Name:VAN DINTER
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 1:7900 E GREEN LAKE DR N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4800
Mailing Address - Country:US
Mailing Address - Phone:206-985-2236
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREEN LAKE DR N
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4800
Practice Address - Country:US
Practice Address - Phone:206-985-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8364598Medicaid
WAP00325142OtherRAILROAD MC#
WA0039585OtherLABOR AND INDUSTRIES #
WA2241VAOtherBLUE SHIELD#
WAUS2456218OtherAETNA SPECIALIST PIN
WAP00325142OtherRAILROAD MC#
WAUS2456218OtherAETNA SPECIALIST PIN