Provider Demographics
NPI:1639544943
Name:PEDREY, KEVIN (LMP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PEDREY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4107
Mailing Address - Country:US
Mailing Address - Phone:360-477-8553
Mailing Address - Fax:360-443-4203
Practice Address - Street 1:145 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-4107
Practice Address - Country:US
Practice Address - Phone:360-477-8553
Practice Address - Fax:360-443-4203
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist