Provider Demographics
NPI:1104440494
Name:FRENTRESS, KATELYN (DPT)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:FRENTRESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9009 NE 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0730
Mailing Address - Country:US
Mailing Address - Phone:650-279-4102
Mailing Address - Fax:
Practice Address - Street 1:900 NE 139TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2519
Practice Address - Country:US
Practice Address - Phone:360-573-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61071975225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2158301Medicaid