Provider Demographics
NPI:1619035912
Name:CRINKLAW, KENNETH FREDRICK (MSPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:FREDRICK
Last Name:CRINKLAW
Suffix:
Gender:M
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:FREDRICK
Other - Last Name:CRINKLAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16261 REDMOND WAY
Mailing Address - Street 2:# 100
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3833
Mailing Address - Country:US
Mailing Address - Phone:425-881-3001
Mailing Address - Fax:425-881-3585
Practice Address - Street 1:16261 REDMOND WAY
Practice Address - Street 2:# 100
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3833
Practice Address - Country:US
Practice Address - Phone:425-881-3001
Practice Address - Fax:425-881-3585
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist