Provider Demographics
NPI:1295887792
Name:REYNOLDS, ELIZABETH ANN (MPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:KACINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21932 3RD DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8270
Mailing Address - Country:US
Mailing Address - Phone:425-486-8017
Mailing Address - Fax:
Practice Address - Street 1:21932 3RD DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8270
Practice Address - Country:US
Practice Address - Phone:425-486-8017
Practice Address - Fax:425-486-8017
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217178OtherDEPT. OF LABOR & INDUSTRY
WA8864132Medicare ID - Type Unspecified