Individual
KYLE DUANE MAHLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1408 N LOUISIANA ST, SUITE 104-A, KENNEWICK, WA 99336-7167
(509) 783-1962
(509) 783-1706
Mailing address
11481 SW HALL BLVD, SUITE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60093188
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0251343
WASHINGTON L&I
WA
05
—
1396973517
—
WA
05
—
8561995
—
WA
01
—
P00742614
RR MEDICARE
WA
Enumeration date
06/25/2009
Last updated
11/08/2010
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