Provider Demographics
NPI:1194843557
Name:RALSTON, KATHRYN E (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:RALSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16219 SE 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8904
Mailing Address - Country:US
Mailing Address - Phone:360-253-4020
Mailing Address - Fax:360-604-9293
Practice Address - Street 1:16219 SE 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8904
Practice Address - Country:US
Practice Address - Phone:360-253-4020
Practice Address - Fax:360-604-9293
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2257225100000X
WA8021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8871441Medicare PIN