Provider Demographics
NPI:1861732455
Name:HUMMEL-BERRY, KATHLEEN H (PT, PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:H
Last Name:HUMMEL-BERRY
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6332
Mailing Address - Country:US
Mailing Address - Phone:253-222-5222
Mailing Address - Fax:
Practice Address - Street 1:2722 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6332
Practice Address - Country:US
Practice Address - Phone:253-222-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252-08---0001018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist