Provider Demographics
NPI:1508410663
Name:KVAMME, SHELLY MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:MARIE
Last Name:KVAMME
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 1:12703 217TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-3906
Mailing Address - Country:US
Mailing Address - Phone:206-920-2111
Mailing Address - Fax:
Practice Address - Street 1:15510 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-6000
Practice Address - Country:US
Practice Address - Phone:206-920-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000093932081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00009393Medicaid