Provider Demographics
NPI:1417251620
Name:RAYNER, KRISTEN (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RAYNER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OLYMPIA AVE NE BOX 12
Mailing Address - Street 2:SUITE 238
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4119
Mailing Address - Country:US
Mailing Address - Phone:425-988-4000
Mailing Address - Fax:
Practice Address - Street 1:401 OLYMPIA AVE NE BOX 12
Practice Address - Street 2:SUITE 238
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4119
Practice Address - Country:US
Practice Address - Phone:425-988-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60088318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist