Provider Demographics
NPI:1255570248
Name:SHELL, KATIE ELIZABETH
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:SHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 45
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2496
Mailing Address - Country:US
Mailing Address - Phone:425-391-4766
Mailing Address - Fax:425-657-0630
Practice Address - Street 1:317 NW GILMAN BLVD
Practice Address - Street 2:SUITE 45
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2496
Practice Address - Country:US
Practice Address - Phone:425-391-4766
Practice Address - Fax:425-657-0630
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60043692172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist