Provider Demographics
NPI:1851818546
Name:JONAS, KELSEY N (PT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:N
Last Name:JONAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 SW 117TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8905
Mailing Address - Country:US
Mailing Address - Phone:503-662-6403
Mailing Address - Fax:
Practice Address - Street 1:735 SW 158TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4952
Practice Address - Country:US
Practice Address - Phone:503-597-0035
Practice Address - Fax:503-726-5490
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist