Provider Demographics
NPI:1275882672
Name:IMONDI, KELSEY WHITE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:WHITE
Last Name:IMONDI
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9414 NE FOURTH PLAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9414 NE FOURTH PLAIN RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6109
Practice Address - Country:US
Practice Address - Phone:360-892-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603004142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics