Provider Demographics
NPI:1639320062
Name:LEE, KELCY L (DPT)
Entity Type:Individual
Prefix:
First Name:KELCY
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELCY
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3515 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5640
Mailing Address - Country:US
Mailing Address - Phone:206-402-5483
Mailing Address - Fax:
Practice Address - Street 1:3515 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5640
Practice Address - Country:US
Practice Address - Phone:206-402-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60022081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1639320062Medicaid
WAP00836813OtherRR MEDICARE
WA8525891Medicaid
WA8525891Medicaid