Michael Stuart Kenniston, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60936491 Issued in WA

Practice address

800 10TH St
Snohomish, WA 98290-2131

Phone

(360) 568-3161

NPI assigned

Jun 5, 2019

Sex

Male

Sole proprietor

No

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": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1205494051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 114TH AVE SE",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982587922",
            "telephone_number": "916-759-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 10TH ST",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982902131",
            "telephone_number": "360-568-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNISTON",
        "first_name": "MICHAEL",
        "middle_name": "STUART",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60936491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Snohomish, WA
• Providers in Snohomish, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.