Provider Demographics
NPI:1538112073
Name:HEDEEN, KARL H (PT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:H
Last Name:HEDEEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-9768
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:27500 102ND AVE NW
Practice Address - Street 2:SUITE 1
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8092
Practice Address - Country:US
Practice Address - Phone:360-629-9768
Practice Address - Fax:360-629-7632
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR79164Medicare UPIN