Provider Demographics
NPI:1689736332
Name:BARNES, KENNETH LEE
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:LEE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:31501 106TH PL SE APT P3
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3066
Mailing Address - Country:US
Mailing Address - Phone:253-939-5122
Mailing Address - Fax:
Practice Address - Street 1:6603 220TH ST SW
Practice Address - Street 2:SUITE 1-C
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2186
Practice Address - Country:US
Practice Address - Phone:425-776-1056
Practice Address - Fax:425-776-4357
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist