Provider Demographics
NPI:1083327811
Name:PHATCHARAPHUWADIN, KANYARAT (LMT)
Entity Type:Individual
Prefix:
First Name:KANYARAT
Middle Name:
Last Name:PHATCHARAPHUWADIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KANYARAT
Other - Middle Name:
Other - Last Name:PHOCAEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMY
Mailing Address - Street 1:15436 BEL-RED RD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15436 BEL-RED RD REDMOND
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-274-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61106687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist