Provider Demographics
NPI:1326295924
Name:KILGUS, ALYSON LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:LEIGH
Last Name:KILGUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:LEIGH
Other - Last Name:SUCHLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:315 MARTIN L KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4234
Mailing Address - Country:US
Mailing Address - Phone:253-891-7490
Mailing Address - Fax:253-863-1052
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:#202
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-847-3700
Practice Address - Fax:256-847-9622
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60028702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291093OtherDEPT. OF LABOR AND INDUSTRIES
WAP00725348OtherMEDICARE RAILROAD
WA8520769Medicaid