Provider Demographics
NPI:1396565263
Name:KAISER, MAKENZI (DPT)
Entity type:Individual
Prefix:
First Name:MAKENZI
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 SE 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1456
Mailing Address - Country:US
Mailing Address - Phone:866-839-6979
Mailing Address - Fax:916-913-5646
Practice Address - Street 1:13555 SE 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1456
Practice Address - Country:US
Practice Address - Phone:866-839-6979
Practice Address - Fax:916-913-5646
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215866225100000X
DCPT210002342225100000X
WAPT61558248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist