Provider Demographics
NPI:1033283767
Name:KONVALIN, AMY D (MPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:KONVALIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:D
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:23745 225TH WAY SE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5294
Mailing Address - Country:US
Mailing Address - Phone:360-367-0970
Mailing Address - Fax:425-651-2486
Practice Address - Street 1:23745 225TH WAY SE
Practice Address - Street 2:SUITE 215
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5294
Practice Address - Country:US
Practice Address - Phone:360-367-0970
Practice Address - Fax:425-651-2486
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist