Provider Demographics
NPI:1578101416
Name:AU, KENDAL W W L (LMT)
Entity Type:Individual
Prefix:
First Name:KENDAL
Middle Name:W W L
Last Name:AU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 35TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-7002
Mailing Address - Country:US
Mailing Address - Phone:510-832-7493
Mailing Address - Fax:
Practice Address - Street 1:3400 HARBOR AVE SW STE 219
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2396
Practice Address - Country:US
Practice Address - Phone:510-832-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60941687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist