Provider Demographics
NPI:1184970832
Name:KOKES, JENNA L (PT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:KOKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0814
Mailing Address - Country:US
Mailing Address - Phone:509-996-8234
Mailing Address - Fax:509-996-2193
Practice Address - Street 1:202 WHITE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9774
Practice Address - Country:US
Practice Address - Phone:509-996-8234
Practice Address - Fax:509-996-2193
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60290704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0298275OtherL&I
WAG8913184Medicare PIN
WA0298275OtherL&I