Individual
KRISTY KEI CANOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
720 12TH ST SE, AUBURN, WA 98002-6708
(253) 735-3606
(253) 351-9807
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60389551
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0316219
DEPT. OF LABOR AND INDUSTRIES
WA
05
—
1871927558
—
WA
Enumeration date
08/29/2013
Last updated
04/28/2023
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