Provider Demographics
NPI:1780090209
Name:RICKABAUGH, KELSEY LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LAUREN
Last Name:RICKABAUGH
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 1:211 VAN SCOYOC AVE SW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360
Mailing Address - Country:US
Mailing Address - Phone:360-872-0315
Mailing Address - Fax:
Practice Address - Street 1:211 VAN SCOYOC AVE SW
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360
Practice Address - Country:US
Practice Address - Phone:360-872-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60449641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist