Provider Demographics
NPI:1699396614
Name:RUDINOW, KAJA (PTA)
Entity type:Individual
Prefix:
First Name:KAJA
Middle Name:
Last Name:RUDINOW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17426 BOTHELL WAY NE UNIT A102
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1948
Mailing Address - Country:US
Mailing Address - Phone:425-420-7782
Mailing Address - Fax:
Practice Address - Street 1:1448 NW MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3743
Practice Address - Country:US
Practice Address - Phone:206-860-2210
Practice Address - Fax:206-860-4461
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60043637225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant