Provider Demographics
NPI:1871556886
Name:BENNETT, KIMBERLY D (PT, PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0759
Mailing Address - Country:US
Mailing Address - Phone:206-778-6405
Mailing Address - Fax:206-322-9169
Practice Address - Street 1:1125 E OLIVE ST STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-8406
Practice Address - Country:US
Practice Address - Phone:206-486-0710
Practice Address - Fax:206-322-9169
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000029062251X0800X
WAPT00002906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS81735Medicare UPIN
WAG8871453Medicare PIN
WAGAB15808Medicare PIN