Provider Demographics
NPI:1013332899
Name:KRAYNAK, KATHRYN MARY (PT, C/NDT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARY
Last Name:KRAYNAK
Suffix:
Gender:F
Credentials:PT, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 FIELDSTON RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7824
Mailing Address - Country:US
Mailing Address - Phone:360-319-8440
Mailing Address - Fax:
Practice Address - Street 1:6041 VISTA DR
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9317
Practice Address - Country:US
Practice Address - Phone:360-383-9200
Practice Address - Fax:360-383-9201
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000053892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics