Provider Demographics
NPI:1659828911
Name:KILLINGBECK, KATHRYN (LMP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KILLINGBECK
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 1:14614 250TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7695
Mailing Address - Country:US
Mailing Address - Phone:253-503-9155
Mailing Address - Fax:
Practice Address - Street 1:8112 112TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7815
Practice Address - Country:US
Practice Address - Phone:253-970-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-04
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60643920225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist