Basic Information
Provider Information
NPI: 1740438555
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAYA
FirstName: RYAN
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1188 106TH AVE NE
Address2: SUITE 100
City: BELLEVUE
State: WA
PostalCode: 980048614
CountryCode: US
TelephoneNumber: 4254544864
FaxNumber: 4256463901
Practice Location
Address1: 1188 106TH AVE NE
Address2: SUITE 100
City: BELLEVUE
State: WA
PostalCode: 980048614
CountryCode: US
TelephoneNumber: 4254552630
FaxNumber: 4256463901
Other Information
ProviderEnumerationDate: 09/04/2008
LastUpdateDate: 02/23/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT60040696WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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