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Individual

JEANETTE M MCKIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
5765 LITTLEROCK RD SW STE 107, TUMWATER, WA 98512-7311
(564) 999-4146
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424

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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