Provider Demographics
NPI:1972836658
Name:KELLOW, NOLAN WESLEY (DPT)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:WESLEY
Last Name:KELLOW
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:144 169TH ST S
Practice Address - Street 2:SUITE B
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8201
Practice Address - Country:US
Practice Address - Phone:253-846-8918
Practice Address - Fax:253-846-8126
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60100044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0048KEOtherREGENCE BLUE SHIELD
WA0253931OtherLABOR AND INDUSTRIES
WA0253931OtherLABOR AND INDUSTRIES