Basic Information
| Provider Information | |||||||||
| NPI: | 1285740449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIASECKI | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18404 102ND AVE NE | ||||||||
| Address2: | STE A | ||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980113380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 2069331030 | ||||||||
| Practice Location | |||||||||
| Address1: | 4744 41ST AVE SW | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069331030 | ||||||||
| FaxNumber: | 2069331032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT00008038 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.