Provider Demographics
NPI:1508132077
Name:KAULFUSS, RACHAEL LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:KAULFUSS
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 1:20600 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8643
Mailing Address - Country:US
Mailing Address - Phone:425-320-7288
Mailing Address - Fax:
Practice Address - Street 1:20600 CRAWFORD RD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8643
Practice Address - Country:US
Practice Address - Phone:425-320-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60175070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist