Provider Demographics
NPI:1396234472
Name:WASHINGTON, KATHRYN MARIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1350
Mailing Address - Country:US
Mailing Address - Phone:810-667-5500
Mailing Address - Fax:
Practice Address - Street 1:1057 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4404
Practice Address - Country:US
Practice Address - Phone:810-667-5514
Practice Address - Fax:810-667-5514
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist