Provider Demographics
NPI:1073163630
Name:TROM, KELLI L (DPT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:TROM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LEA
Other - Last Name:MINISSALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2360 N ALADDIN RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5359
Mailing Address - Country:US
Mailing Address - Phone:509-808-0003
Mailing Address - Fax:509-624-2817
Practice Address - Street 1:9725 W SUNSET HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9426
Practice Address - Country:US
Practice Address - Phone:509-624-4100
Practice Address - Fax:509-624-2297
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60956311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist