Provider Demographics
NPI:1902340102
Name:KELLETT, STEPHEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KELLETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22659 PACIFIC HWY S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5155
Mailing Address - Country:US
Mailing Address - Phone:206-824-3668
Mailing Address - Fax:
Practice Address - Street 1:22659 PACIFIC HWY S
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5155
Practice Address - Country:US
Practice Address - Phone:206-824-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60705963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist