Provider Demographics
NPI:1750409439
Name:YOUNG, KATHLEEN TERESA (MPT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:TERESA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 198TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-5041
Mailing Address - Country:US
Mailing Address - Phone:425-497-8180
Mailing Address - Fax:425-497-8358
Practice Address - Street 1:2569 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5549
Practice Address - Country:US
Practice Address - Phone:425-497-8180
Practice Address - Fax:425-497-8358
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8385742OtherDHSH
WA8802330Medicare ID - Type Unspecified