Individual
KENNETH BRUK BALLENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
19022 AURORA AVE N STE B, SHORELINE, WA 98133-3915
(206) 788-8807
(866) 329-2785
Mailing address
23636 HIGHWAY 99, SUITE F, EDMONDS, WA 98026
(206) 788-8807
(866) 329-2785
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7473
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165921
WA STATE L&I
WA
05
—
8331621
—
WA
Enumeration date
08/31/2006
Last updated
07/21/2022
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