Provider Demographics
NPI:1275685372
Name:UCHIDA, KIRSTIN (PT)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:UCHIDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:23925 225TH WAY SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5233
Mailing Address - Country:US
Mailing Address - Phone:425-433-0123
Mailing Address - Fax:425-433-0733
Practice Address - Street 1:23925 225TH WAY SE
Practice Address - Street 2:SUITE B
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5233
Practice Address - Country:US
Practice Address - Phone:425-433-0123
Practice Address - Fax:425-433-0733
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist