Provider Demographics
NPI:1811516297
Name:SHIVELY, KACIE MICHELLE (PT, DPT, ACSM-EP)
Entity type:Individual
Prefix:DR
First Name:KACIE
Middle Name:MICHELLE
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:PT, DPT, ACSM-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-4085
Mailing Address - Country:US
Mailing Address - Phone:509-947-8600
Mailing Address - Fax:509-236-8095
Practice Address - Street 1:5020 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1951
Practice Address - Country:US
Practice Address - Phone:509-934-3309
Practice Address - Fax:509-236-8095
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60723995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist