Provider Demographics
NPI:1679902761
Name:DEROSIER, KATHRYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:DEROSIER
Suffix:
Gender:F
Credentials:PT
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 1073
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-1073
Mailing Address - Country:US
Mailing Address - Phone:509-276-8529
Mailing Address - Fax:
Practice Address - Street 1:1007 N ARNIM STREET
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-1073
Practice Address - Country:US
Practice Address - Phone:509-276-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist