Provider Demographics
NPI:1689876740
Name:FREY, KENDRA J
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:J
Last Name:FREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:JOHANNA
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-258-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU20001192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4613DEOtherREGENCE
WA8343947OtherDSHS
WA8490674OtherDSHS
WA8945378OtherL&I CRIME
WA0223978OtherDEPARTMEMT OF L&I
WA5065DEOtherREGENCE
WAP00461042OtherRAILROAD MEDICARE
WA3819DEOtherREGENCE
WA3716DEOtherREGENCE
WA5305FROtherREGENCE
WA8945108OtherL&I CRIME VICTIMS
WA6713DEOtherREGENCE
WA8343949OtherDSHS
WA8945380OtherL&I CRIME
WA9312078OtherAETNA
WA8490674OtherDSHS