Basic Information
| Provider Information | |||||||||
| NPI: | 1982152419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRASNER-ROSENSTEIN | ||||||||
| FirstName: | SHIRI | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KRASNER | ||||||||
| OtherFirstName: | SHIRI | ||||||||
| OtherMiddleName: | K. | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7320 216TH ST SW STE 320 | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256733900 | ||||||||
| FaxNumber: | 4256733910 | ||||||||
| Practice Location | |||||||||
| Address1: | 15808 MILL CREEK BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980121500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252984072 | ||||||||
| FaxNumber: | 4252984076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 226300000X | PT00003958 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Kinesiotherapist | 225100000X | PT00003958 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 366390 | 01 | WA | WA LABOR & INDUSTRIES | OTHER | 2070204 | 05 | WA | MEDICAID |