Provider Demographics
NPI:1750937405
Name:FRIEND, MERCEDES CHRISTINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:CHRISTINA
Last Name:FRIEND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7108
Mailing Address - Country:US
Mailing Address - Phone:253-854-5660
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:6419 LAKEWOOD DR W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3331
Practice Address - Country:US
Practice Address - Phone:253-531-8873
Practice Address - Fax:253-854-7025
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60993293225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2141589Medicaid