Provider Demographics
NPI:1730817016
Name:MOHN, KATHLEEN NERYS (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NERYS
Last Name:MOHN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22500 NE MARKETPLACE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2033
Mailing Address - Country:US
Mailing Address - Phone:425-836-1034
Mailing Address - Fax:
Practice Address - Street 1:4935 LAKEMONT BLVD SE STE 4
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-7800
Practice Address - Country:US
Practice Address - Phone:425-956-3838
Practice Address - Fax:425-947-5931
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61313391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist