Provider Demographics
NPI:1457428526
Name:SCHUYLER WHITE, KIM A (PT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:A
Last Name:SCHUYLER WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:SCHUYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:14410 SE PETROVITSKY RD
Practice Address - Street 2:STE 202
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-272-0252
Practice Address - Fax:425-272-0291
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669275Medicaid
WA1457428526Medicaid
WAP01361144OtherRR MEDICARE
WA152682OtherDEPT OF L & I
WA1350SCOtherREGENCE BS
WAP01398088OtherRR MEDICARE PTAN
WAG8925422Medicare PIN
WAG8901050Medicare PIN
WA1350SCOtherREGENCE BS
WAG8923505Medicare PIN
WAP01361144OtherRR MEDICARE