Provider Demographics
NPI:1316011455
Name:KINNEEN, ERIN M (MSPT, DMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:KINNEEN
Suffix:
Gender:F
Credentials:MSPT, DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:STE. 103
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-8142
Practice Address - Fax:253-582-8160
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301799OtherL & I
WA0301800OtherL & I
WA0302294OtherL & I
WA0301795OtherL & I
WAG8914525Medicare PIN
WAG8912938Medicare PIN
WAG8912939Medicare PIN
WAG8912937Medicare PIN