Provider Demographics
NPI:1891565172
Name:SCHWERDTFEGER, KATRINA LYNNE (MS, PTA, LMT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNNE
Last Name:SCHWERDTFEGER
Suffix:
Gender:F
Credentials:MS, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 YEW ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-8813
Mailing Address - Country:US
Mailing Address - Phone:206-403-5686
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST STE 617
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5024
Practice Address - Country:US
Practice Address - Phone:360-206-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60575719225200000X
WA61368535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60575719OtherDOH
WA61368535OtherDOH