Provider Demographics
NPI:1285740449
Name:PIASECKI, KEVIN R (MSPT, OCS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:PIASECKI
Suffix:
Gender:M
Credentials:MSPT, OCS
Other - Prefix:
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Mailing Address - Street 1:18404 102ND AVE NE
Mailing Address - Street 2:STE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:206-933-1030
Practice Address - Street 1:4744 41ST AVE SW
Practice Address - Street 2:SUITE 105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4570
Practice Address - Country:US
Practice Address - Phone:206-933-1030
Practice Address - Fax:206-933-1032
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000080382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic