Provider Demographics
NPI:1215328307
Name:PURYEAR, KAYLEE (LMP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17528 MERIDIAN E STE 207
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6286
Mailing Address - Country:US
Mailing Address - Phone:253-445-9030
Mailing Address - Fax:
Practice Address - Street 1:17528 MERIDIAN E STE 207
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6286
Practice Address - Country:US
Practice Address - Phone:253-445-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60529299225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA731692370OtherTAX ID