Provider Demographics
NPI:1134499569
Name:VANHOVE, KELLY JOHN (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JOHN
Last Name:VANHOVE
Suffix:
Gender:M
Credentials:PT, DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 NE RAVENNA BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8448
Mailing Address - Country:US
Mailing Address - Phone:602-300-9273
Mailing Address - Fax:
Practice Address - Street 1:432 NE RAVENNA BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8448
Practice Address - Country:US
Practice Address - Phone:602-300-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 602562102255A2300X
WAPT60745535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer