Individual
JEANETTE M MCKIM
Active
Individual
JEANETTE M MCKIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT00008796
WA
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0208917
DEPT. OF LABOR & INDUSTRY
WA
01
—
3246TO
REGENCE
WA
01
—
3686TO
REGENCE
WA
01
—
4035TO
REGENCE BLUE SHIELD
WA
01
—
5682TO
REGENCE
WA
01
—
6572TO
REGENCE
WA
01
—
710883456-98502-A002
TRICARE
WA
01
—
7393456
AETNA
WA
05
—
8455016
—
WA
01
—
P00428344
RAILROAD MEDICARE
WA
Enumeration date
09/29/2005
Last updated
05/14/2021
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