Basic Information
| Provider Information | |||||||||
| NPI: | 1730817016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | NERYS | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22500 NE MARKETPLACE DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980532033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258361034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4935 LAKEMONT BLVD SE STE 4 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980067800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259563838 | ||||||||
| FaxNumber: | 4259475931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2022 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT61313391 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.