Provider Demographics
NPI:1376273920
Name:KREISER, KYNDAL C
Entity Type:Individual
Prefix:
First Name:KYNDAL
Middle Name:C
Last Name:KREISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 KING ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-783-6761
Practice Address - Street 1:1316 KING ST STE 3
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6263
Practice Address - Country:US
Practice Address - Phone:360-306-8073
Practice Address - Fax:360-783-6761
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61311675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist