Provider Demographics
NPI:1023301868
Name:KINETIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:KINETIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAWN
Authorized Official - Middle Name:JENNIE
Authorized Official - Last Name:COUSSENS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:206-632-0163
Mailing Address - Street 1:4828 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4415
Mailing Address - Country:US
Mailing Address - Phone:206-632-0163
Mailing Address - Fax:206-932-2353
Practice Address - Street 1:4828 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4415
Practice Address - Country:US
Practice Address - Phone:206-632-0163
Practice Address - Fax:206-932-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
WA602928536261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy