Provider Demographics
NPI:1851065585
Name:NEWTON, KELLI (LMT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KELL
Other - Middle Name:MICHELLE
Other - Last Name:REID NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:14823 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8235
Mailing Address - Country:US
Mailing Address - Phone:206-353-6003
Mailing Address - Fax:
Practice Address - Street 1:19502 48TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5507
Practice Address - Country:US
Practice Address - Phone:425-582-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist