Provider Demographics
NPI:1215131529
Name:KENISON, CODY THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:THOMAS
Last Name:KENISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:201 W NORTH RIVER DR
Practice Address - Street 2:SUITE 510
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2284
Practice Address - Country:US
Practice Address - Phone:509-323-0066
Practice Address - Fax:509-323-0067
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60099101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0256347OtherL&I
WA0007KEOtherREGENCE
WA0052KEOtherREGENCE
WA8599995OtherDSHS
WA0253448OtherL&I
WA0001KEOtherREGENCE
WA0002KEOtherREGENCE
WA0003KEOtherREGENCE
WA0004KEOtherREGENCE
WA0006KEOtherREGENCE
WA0258152OtherL&I
WAP00907202OtherMEDICARE RAILROAD
WA0005KEOtherREGENCE
WA0008KEOtherREGENCE
WA0091KEOtherREGENCE
WA0004KEOtherREGENCE
WA0001KEOtherREGENCE
WAG8936783Medicare PIN
WAG8884316Medicare PIN