Kyle Duane Mahlum, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60093188 Issued in WA

Practice address

1408 N Louisiana St
Suite 104-a
Kennewick, WA 99336-7167

Phone

(509) 783-1962

Fax

(509) 783-1706

NPI assigned

Jun 25, 2009

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

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapeutic Associates Inc

  • Physical Therapist
  • Bothell, WA
  • NPI 1114376563
  NPD (past)
• Therapeutic Associates Inc

  • Physical Therapist
  • Portland, OR
  • NPI 1700862000
  NPD (past)

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1396973517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11481 SW HALL BLVD",
            "address_2": "SUITE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238403",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 N LOUISIANA ST",
            "address_2": "SUITE 104-A",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367167",
            "telephone_number": "509-783-1962",
            "fax_number": "509-783-1706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHLUM",
        "first_name": "KYLE",
        "middle_name": "DUANE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60093188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON L&I",
            "identifier": "0251343",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8561995",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00742614",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396973517",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magdalena Place Afh LLC
• Rongie Bren Songco Magdangal, PT
• Stanton Magid
• Tyler Magid
• Priya Mahal
• Samantha Maiden
• Sandra Maine, M.S., CCC-SLP
• Jessica K Makovsky, LICSW, MHP, CMHS
• Sukhmeet Mand, DC
• Sue A Mandell, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.