Provider Demographics
NPI:1548692296
Name:LINDSTROM, KELLEY ANN (DPT)
Entity type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:ANN
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 SW BARROWS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8778
Mailing Address - Country:US
Mailing Address - Phone:971-930-4433
Mailing Address - Fax:971-238-2073
Practice Address - Street 1:15000 SW BARROWS RD STE 201
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8778
Practice Address - Country:US
Practice Address - Phone:971-930-4433
Practice Address - Fax:971-238-2073
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60312225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist