Provider Demographics
NPI:1457468365
Name:KLOTTER, KELLY L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:KLOTTER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-1100
Mailing Address - Fax:425-304-1102
Practice Address - Street 1:3916 148TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-304-1100
Practice Address - Fax:425-304-1102
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000080562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336356Medicaid
WA8336356Medicaid