| Doctor Name: | PETER KELLEY JANICKI |
| NPI Number: | 1003163866 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT60282435 |
| Business Practice Address: | 3912 10th St Se Suite 101 Puyallup, WA - 983742188 |
| Business Phone Number: | 2538484700 |
| Business Fax Number: | 2538482284 |
| Mailing Address: | Po Box 2170, SUMNER |
| State: | WA |
| Postal Code: | 983900480 |
| Phone Number: | 2538402313 |
| Fax Number: | 2538406340 |
| NPI Enumeration Date: | 08/11/2012 |
| NPI Last Update Date: | 08/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT60282435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |