Individual
JUSTIN THOMAS KANE
Active
Individual
JUSTIN THOMAS KANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-700
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100007419
BLUE SHIELD
ID
05
—
004401801
—
ID
01
—
0100472
WASHINGTON LABOR & INDUST
WA
01
—
T5501
BLUE CROSS
ID
Enumeration date
07/04/2006
Last updated
03/06/2009
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