Individual
KYLE DUANE MAHLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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
Update your record
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