Provider Demographics
NPI:1154306967
Name:KORTHUIS, STEVEN KENNETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KENNETH
Last Name:KORTHUIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 FRONT ST
Mailing Address - Street 2:STE A
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1729
Mailing Address - Country:US
Mailing Address - Phone:360-354-0585
Mailing Address - Fax:360-354-1098
Practice Address - Street 1:1824 FRONT ST
Practice Address - Street 2:STE A
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1729
Practice Address - Country:US
Practice Address - Phone:360-354-0585
Practice Address - Fax:360-354-1098
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00007181OtherWA STATE PT LICENSE
WAPT00007181OtherWA STATE PT LICENSE
S35546Medicare UPIN