Provider Demographics
NPI:1548863418
Name:BURCHETT, KIRSTIN MARIE (MPT)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIE
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:MARIE
Other - Last Name:HOUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 PACIFIC AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4442
Mailing Address - Country:US
Mailing Address - Phone:253-383-6205
Mailing Address - Fax:
Practice Address - Street 1:950 PACIFIC AVE STE 900
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4425
Practice Address - Country:US
Practice Address - Phone:253-383-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist