Provider Demographics
NPI:1942075320
Name:MORAUSKE, KALVIN WILLIAM
Entity Type:Individual
Prefix:
First Name:KALVIN
Middle Name:WILLIAM
Last Name:MORAUSKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SW 23RD CIR
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-8492
Mailing Address - Country:US
Mailing Address - Phone:360-903-1893
Mailing Address - Fax:
Practice Address - Street 1:412 SW 23RD CIR
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8492
Practice Address - Country:US
Practice Address - Phone:360-903-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist