Provider Demographics
NPI:1558443317
Name:SHAPIRO, KATHLEEN (RPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21339 SWAN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9482
Mailing Address - Country:US
Mailing Address - Phone:360-428-2030
Mailing Address - Fax:360-428-2030
Practice Address - Street 1:21339 SWAN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-9482
Practice Address - Country:US
Practice Address - Phone:360-428-2030
Practice Address - Fax:360-428-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000008662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics