Provider Demographics
NPI:1508171687
Name:KANE, CARRIE DANYEL (DPT)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:DANYEL
Last Name:KANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARTHUR CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6946
Mailing Address - Country:US
Mailing Address - Phone:633-408-3295
Mailing Address - Fax:
Practice Address - Street 1:1871 NW GILMAN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-657-0620
Practice Address - Fax:425-677-7415
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60166585225100000X
VT040.0118377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist