Healthcare Provider Details

I. General information

NPI: 1457611857
Provider Name (Legal Business Name): KELSEY RENE MOLLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY R LUKER DPT

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207-5000
US

IV. Provider business mailing address

1400 16TH ST
DENVER CO
80202-1470
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4096
  • Fax:
Mailing address:
  • Phone: 877-807-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60273291
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number60273291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: