Basic Information
Provider Information
NPI: 1043944671
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAIN
FirstName: ALICIA
MiddleName: ANN
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6050 TACOMA MALL BLVD STE 300
Address2:  
City: TACOMA
State: WA
PostalCode: 984096828
CountryCode: US
TelephoneNumber: 2535815200
FaxNumber:  
Practice Location
Address1: 10550 HARBOR HILL DR
Address2:  
City: GIG HARBOR
State: WA
PostalCode: 983328944
CountryCode: US
TelephoneNumber: 2536495182
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2022
LastUpdateDate: 07/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT61302232WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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