Jerold R Kutzke, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160041247 Issued in WA

Practice address

19401 40TH Ave W
Suite 330
Lynnwood, WA 98036-4612

Phone

(425) 670-9987

Fax

(425) 744-7233

NPI assigned

Sep 5, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1194150433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19401 40TH AVE W",
            "address_2": "SUITE 330",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364612",
            "telephone_number": "425-670-9987",
            "fax_number": "425-744-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 40TH AVE W",
            "address_2": "SUITE 330",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364612",
            "telephone_number": "425-670-9987",
            "fax_number": "425-744-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTZKE",
        "first_name": "JEROLD",
        "middle_name": "R",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160041247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalya Yevgenievna Kumar, FNP-BC
• Melanie Kuoch
• Wendy Nelcene Kuppler, PHARMACY TECH A
• Geethanjali Kuppusamy
• Nataliya M Kurkov, LMP
• Kimberly Eileen Kuzara, LMP
• Eddie P Kwan, OD
• Kwang Jin Hahn DDS, PLLC
• Jennifer Kwok, O.D.
• Kyle Tanaka DDS PLLC

• Physical Therapy Assistant in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.