Provider Demographics
NPI:1457611857
Name:MOLLER, KELSEY RENE (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENE
Last Name:MOLLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:LUKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1400 16TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1470
Mailing Address - Country:US
Mailing Address - Phone:877-807-8277
Mailing Address - Fax:
Practice Address - Street 1:2000 W MARINE VIEW DR BLDG 2010
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-5000
Practice Address - Country:US
Practice Address - Phone:425-304-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602732912251X0800X
WAPT60273291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8909649Medicare UPIN