Provider Demographics
NPI:1144201484
Name:KAEKA, SUSAN MIYE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MIYE
Last Name:KAEKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MIYE
Other - Last Name:MAYENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2102 N. PEARL #203
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2550
Mailing Address - Country:US
Mailing Address - Phone:253-756-7878
Mailing Address - Fax:253-756-9634
Practice Address - Street 1:2102 N PEARL #203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-756-7878
Practice Address - Fax:253-756-9634
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427874Medicaid
WAAB37668Medicare ID - Type Unspecified