Provider Demographics
NPI:1477653434
Name:KELLY LUNDA PHYSICAL THERAPY P.S.
Entity Type:Organization
Organization Name:KELLY LUNDA PHYSICAL THERAPY P.S.
Other - Org Name:KLS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:360-733-1682
Mailing Address - Street 1:2804 UNDINE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3763
Mailing Address - Country:US
Mailing Address - Phone:360-733-1682
Mailing Address - Fax:360-746-3140
Practice Address - Street 1:960 HARRIS AVE STE 203
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7025
Practice Address - Country:US
Practice Address - Phone:360-733-1682
Practice Address - Fax:360-746-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty