Provider Demographics
NPI:1831172550
Name:SCHUERMAN, KELLI JO (MPT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:JO
Last Name:SCHUERMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:JO
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:101 W CATALDO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-326-7311
Practice Address - Fax:509-326-7314
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
180133OtherWA STATE L & I
WAP01797627OtherRR MEDICARE
WA7080112Medicaid
WA1831172550Medicaid
WA7080112Medicaid
180133OtherWA STATE L & I