Basic Information
| Provider Information | |||||||||
| NPI: | 1689876740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREY | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEUTSCH | ||||||||
| OtherFirstName: | KENDRA | ||||||||
| OtherMiddleName: | JOHANNA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5127 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982065127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252583900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3927 RUCKER AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252583900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PU20001192 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4613DE | 01 | WA | REGENCE | OTHER | 8343947 | 01 | WA | DSHS | OTHER | 8490674 | 01 | WA | DSHS | OTHER | 8945378 | 01 | WA | L&I CRIME | OTHER | 0223978 | 01 | WA | DEPARTMEMT OF L&I | OTHER | 5065DE | 01 | WA | REGENCE | OTHER | P00461042 | 01 | WA | RAILROAD MEDICARE | OTHER | 3819DE | 01 | WA | REGENCE | OTHER | 3716DE | 01 | WA | REGENCE | OTHER | 5305FR | 01 | WA | REGENCE | OTHER | 8945108 | 01 | WA | L&I CRIME VICTIMS | OTHER | 6713DE | 01 | WA | REGENCE | OTHER | 8343949 | 01 | WA | DSHS | OTHER | 8945380 | 01 | WA | L&I CRIME | OTHER | 9312078 | 01 | WA | AETNA | OTHER |