Provider Demographics
NPI:1710377247
Name:KNUTSEN, LADONNA LEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:LEA
Last Name:KNUTSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2525
Mailing Address - Country:US
Mailing Address - Phone:425-681-5159
Mailing Address - Fax:
Practice Address - Street 1:1919 112TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3784
Practice Address - Country:US
Practice Address - Phone:425-513-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60046130225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant