Provider Demographics
NPI:1093094856
Name:DEAN, KELLY S (MPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:DEAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:SPADOLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:113 NE 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2541
Mailing Address - Country:US
Mailing Address - Phone:360-607-6682
Mailing Address - Fax:360-944-0606
Practice Address - Street 1:113 NE 92ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2541
Practice Address - Country:US
Practice Address - Phone:360-607-6682
Practice Address - Fax:360-944-0606
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00008722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist