Provider Demographics
NPI:1871655100
Name:DALE, KATHRYN FONTANA (PT, OCS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FONTANA
Last Name:DALE
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARY FRANCIS
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:STE. 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:STE. 310
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-874-8009
Practice Address - Fax:360-874-8010
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA216083OtherL&I
WA8341794Medicaid
WAG8925925Medicare PIN
WA8341794Medicaid
WAG8925924Medicare PIN