Provider Demographics
NPI:1992377311
Name:VAN HOOK, KELLEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:VAN HOOK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S HAZEL DELL WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-7828
Mailing Address - Country:US
Mailing Address - Phone:503-263-9568
Mailing Address - Fax:
Practice Address - Street 1:200 S HAZEL DELL WAY STE 210
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-7828
Practice Address - Country:US
Practice Address - Phone:503-263-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist