Provider Demographics
NPI:1477986958
Name:KENNEL, NATHAN PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:KENNEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17408 53RD PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3088
Mailing Address - Country:US
Mailing Address - Phone:425-787-5976
Mailing Address - Fax:
Practice Address - Street 1:4700 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6374
Practice Address - Country:US
Practice Address - Phone:206-632-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60382389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist