Provider Demographics
NPI:1295719698
Name:HAHN, KATHRYN MABEL (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MABEL
Last Name:HAHN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:HAHN
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:THERAPEUTIC ASSOCIATES INC STE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:TAI NORTHLAKE PHYSICAL THERAPY STE 140
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4357
Practice Address - Country:US
Practice Address - Phone:206-361-4745
Practice Address - Fax:206-361-4877
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003168225100000X
WI10730-24225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8333726Medicaid
WAAB14529Medicare ID - Type Unspecified