Provider Demographics
NPI:1255622924
Name:DEGAETANI, KERRY O (PT)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:O
Last Name:DEGAETANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4701 SW ADMIRAL WAY # 402
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2340
Mailing Address - Country:US
Mailing Address - Phone:206-972-5978
Mailing Address - Fax:206-322-9169
Practice Address - Street 1:1125 E OLIVE ST STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-8406
Practice Address - Country:US
Practice Address - Phone:206-972-5978
Practice Address - Fax:206-322-9169
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60920912OtherPT LICENSE