Provider Demographics
NPI:1639309446
Name:HINES, KELSEY DENAE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DENAE
Last Name:HINES
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 1:1807 N STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3829
Mailing Address - Country:US
Mailing Address - Phone:253-396-9001
Mailing Address - Fax:253-396-9001
Practice Address - Street 1:1807 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-3829
Practice Address - Country:US
Practice Address - Phone:253-396-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60088389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist