Provider Demographics
NPI:1497895072
Name:FRICK, KELLY A (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:FRICK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16404 SMOKEY POINT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8417
Mailing Address - Country:US
Mailing Address - Phone:360-658-8100
Mailing Address - Fax:360-658-0508
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-658-8100
Practice Address - Fax:360-658-0508
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335358Medicaid
WAAB36419Medicare ID - Type Unspecified