Provider Demographics
NPI:1659001097
Name:KYES, STEPHANIE DAWN (PT, CLT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:KYES
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2501
Mailing Address - Country:US
Mailing Address - Phone:360-329-7052
Mailing Address - Fax:360-329-7053
Practice Address - Street 1:3114 NW RANDALL WAY STE 110
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7676
Practice Address - Country:US
Practice Address - Phone:360-329-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist