Provider Demographics
NPI:1639318777
Name:KAE, MARY ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:KAE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70125
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-0125
Mailing Address - Country:US
Mailing Address - Phone:206-706-7725
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 230
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-6500
Practice Address - Country:US
Practice Address - Phone:206-706-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004016172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist