Provider Demographics
NPI:1952580961
Name:EMERSON, KELLY (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1414
Mailing Address - Country:US
Mailing Address - Phone:253-752-5677
Mailing Address - Fax:253-759-3621
Practice Address - Street 1:3919 S 19TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1414
Practice Address - Country:US
Practice Address - Phone:253-752-5677
Practice Address - Fax:253-759-3621
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist