Provider Demographics
NPI:1609123264
Name:ROUMELIOTIS, KRISTA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:ROUMELIOTIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 164TH AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-658-4980
Mailing Address - Fax:425-658-4977
Practice Address - Street 1:8630 164TH AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:425-658-4977
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60274774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist