Provider Demographics
NPI:1043998750
Name:STEVENS, KELLY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 SW CENTER ST APT 46
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4641
Mailing Address - Country:US
Mailing Address - Phone:719-359-6361
Mailing Address - Fax:
Practice Address - Street 1:5825 NE RAY CIR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6436
Practice Address - Country:US
Practice Address - Phone:503-614-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist