Provider Demographics
NPI:1043795156
Name:STRAUB, KELLEE ASHLEY
Entity Type:Individual
Prefix:
First Name:KELLEE
Middle Name:ASHLEY
Last Name:STRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 VICENTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2740
Mailing Address - Country:US
Mailing Address - Phone:415-661-1015
Mailing Address - Fax:415-661-7984
Practice Address - Street 1:268 REDWOOD SHORES PKWY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1172
Practice Address - Country:US
Practice Address - Phone:650-591-9581
Practice Address - Fax:650-591-9671
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist