Provider Demographics
NPI:1881827681
Name:BERRYMAN, KRISTEN MIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MIE
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MIE
Other - Last Name:KIMOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4455 148TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007
Mailing Address - Country:US
Mailing Address - Phone:425-861-6255
Mailing Address - Fax:425-869-5285
Practice Address - Street 1:4455 148TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:425-861-6255
Practice Address - Fax:425-869-5285
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8633225100000X
WAPT60139732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist