Provider Demographics
NPI:1437409471
Name:VEGA, KATHLEEN GLENESK (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GLENESK
Last Name:VEGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:THOMPSON
Other - Last Name:GLENESK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:21707 103RD AVENUE CT E STE B202
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8308
Mailing Address - Country:US
Mailing Address - Phone:253-655-5841
Mailing Address - Fax:
Practice Address - Street 1:21707 103RD AVENUE CT E STE B202
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8308
Practice Address - Country:US
Practice Address - Phone:253-655-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
33025FMedicare PIN