Provider Demographics
NPI:1962544387
Name:KNOUF, KALISTA (LMP)
Entity type:Individual
Prefix:
First Name:KALISTA
Middle Name:
Last Name:KNOUF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33347 1ST LN S APT D
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6262
Mailing Address - Country:US
Mailing Address - Phone:253-835-1337
Mailing Address - Fax:
Practice Address - Street 1:721 M ST. SE STE #105
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-939-9599
Practice Address - Fax:253-804-5655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215092OtherLABOR & INDUSTRIES