Provider Demographics
NPI:1710028980
Name:REGIS, KRISTINE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:L
Last Name:REGIS
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 1:11805 N CREEK PKWY S
Mailing Address - Street 2:STE 113
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8803
Mailing Address - Country:US
Mailing Address - Phone:425-806-5700
Mailing Address - Fax:425-806-5751
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5030
Practice Address - Country:US
Practice Address - Phone:425-252-4600
Practice Address - Fax:425-252-4477
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8376436Medicaid
WA8800246Medicare ID - Type Unspecified