Provider Demographics
NPI:1164521134
Name:KOWALCHUK, KEELY JEAN (RPT)
Entity Type:Individual
Prefix:MS
First Name:KEELY
Middle Name:JEAN
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 152ND PL NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4209
Mailing Address - Country:US
Mailing Address - Phone:425-455-0699
Mailing Address - Fax:425-455-1541
Practice Address - Street 1:1951 152ND PL NE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4209
Practice Address - Country:US
Practice Address - Phone:425-455-0699
Practice Address - Fax:425-455-1541
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist