Provider Demographics
NPI:1801956800
Name:STUTH, KENTON GERARD (LMP)
Entity type:Individual
Prefix:MR
First Name:KENTON
Middle Name:GERARD
Last Name:STUTH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2938 LIMITED LN NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6500
Mailing Address - Country:US
Mailing Address - Phone:360-866-8940
Mailing Address - Fax:360-866-8943
Practice Address - Street 1:2938 LIMITED LN NW
Practice Address - Street 2:SUITE D
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6500
Practice Address - Country:US
Practice Address - Phone:360-866-8940
Practice Address - Fax:360-866-8943
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA21918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist