Provider Demographics
NPI:1689666323
Name:CALKINS, JEREMY B (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:B
Last Name:CALKINS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 64TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3069
Mailing Address - Country:US
Mailing Address - Phone:253-891-7490
Mailing Address - Fax:253-863-1052
Practice Address - Street 1:16101 64TH ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3069
Practice Address - Country:US
Practice Address - Phone:253-891-7490
Practice Address - Fax:253-863-1052
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7780484OtherAETNA
WA4822CAOtherREGENCE BS
WA8368961Medicaid
WA192087OtherDEPT OF L&I
WA8939557OtherCRIME VICTIMS
WA8368961Medicaid