Provider Demographics
NPI:1699443960
Name:CHAPMAN, KATHRYN BUCK (DPT)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:BUCK
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 S LAVENTURE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-6033
Mailing Address - Country:US
Mailing Address - Phone:360-424-7041
Mailing Address - Fax:360-424-2418
Practice Address - Street 1:1017 20TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2505
Practice Address - Country:US
Practice Address - Phone:360-424-7041
Practice Address - Fax:360-424-2456
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61160473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2189370Medicaid