Provider Demographics
NPI:1043241920
Name:COMPHER, KATHLEEN RADER (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RADER
Last Name:COMPHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 168TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-8652
Mailing Address - Country:US
Mailing Address - Phone:206-368-7402
Mailing Address - Fax:
Practice Address - Street 1:1611 116TH AVENUE NE, SUITE 134
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3063
Practice Address - Country:US
Practice Address - Phone:425-467-7105
Practice Address - Fax:425-467-7135
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist