Provider Demographics
NPI:1750438883
Name:WALLACE, KATHERINE ANN (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 NE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5754
Mailing Address - Country:US
Mailing Address - Phone:206-527-2856
Mailing Address - Fax:206-527-2888
Practice Address - Street 1:5901 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2754
Practice Address - Country:US
Practice Address - Phone:206-527-2800
Practice Address - Fax:206-526-5394
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist