Provider Demographics
NPI:1750449377
Name:MINKE, KRISTEN A (LMT, CLT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:MINKE
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 212TH ST SW APT 214
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7575
Mailing Address - Country:US
Mailing Address - Phone:425-289-9784
Mailing Address - Fax:425-977-8115
Practice Address - Street 1:7500 212TH ST SW STE 108
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7615
Practice Address - Country:US
Practice Address - Phone:425-289-9784
Practice Address - Fax:425-977-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA16054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist