Provider Demographics
NPI:1649414715
Name:HYNNING, KAREN M (PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:HYNNING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:KONDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1070 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-8358
Mailing Address - Country:US
Mailing Address - Phone:360-887-0837
Mailing Address - Fax:360-887-0837
Practice Address - Street 1:1070 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-8358
Practice Address - Country:US
Practice Address - Phone:360-887-0837
Practice Address - Fax:360-887-0837
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160039445225200000X
OR8335225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant