Provider Demographics
NPI:1275907065
Name:WIMETT, KEIGHLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KEIGHLEY
Middle Name:
Last Name:WIMETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 HARRIS PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6507
Mailing Address - Country:US
Mailing Address - Phone:520-444-7601
Mailing Address - Fax:
Practice Address - Street 1:5830 S 300TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2311
Practice Address - Country:US
Practice Address - Phone:253-945-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT605616802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics