Provider Demographics
NPI:1316543879
Name:MCKEE, KELLYE HOWELL (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLYE
Middle Name:HOWELL
Last Name:MCKEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CHALLENGER WAY
Mailing Address - Street 2:STE 104
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5423
Mailing Address - Country:US
Mailing Address - Phone:707-542-5400
Mailing Address - Fax:
Practice Address - Street 1:140 WIKIUP DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7756
Practice Address - Country:US
Practice Address - Phone:707-542-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist