Provider Demographics
NPI:1790931616
Name:HENRICKSEN, KELLI ANN (DPT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:HENRICKSEN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4250 MARTIN WAY E STE 105
Mailing Address - Street 2:PMB 236
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5317
Mailing Address - Country:US
Mailing Address - Phone:360-789-5384
Mailing Address - Fax:360-918-9713
Practice Address - Street 1:3721 GRIFFIN LN SE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2192
Practice Address - Country:US
Practice Address - Phone:360-789-5384
Practice Address - Fax:360-918-9713
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60028377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist