Provider Demographics
NPI:1437426400
Name:KAANDORP, PETRONELLA JOHANNA
Entity type:Individual
Prefix:
First Name:PETRONELLA
Middle Name:JOHANNA
Last Name:KAANDORP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 27TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5904
Mailing Address - Country:US
Mailing Address - Phone:206-501-0937
Mailing Address - Fax:
Practice Address - Street 1:6731 27TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5904
Practice Address - Country:US
Practice Address - Phone:206-501-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA.60239250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist