Healthcare Provider Details

I. General information

NPI: 1851065585
Provider Name (Legal Business Name): KELLI NEWTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELL MICHELLE REID NEWTON LMT

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19502 48TH AVE W
LYNNWOOD WA
98036-5507
US

IV. Provider business mailing address

14823 16TH AVE SE
MILL CREEK WA
98012-8235
US

V. Phone/Fax

Practice location:
  • Phone: 425-582-9951
  • Fax:
Mailing address:
  • Phone: 206-353-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00004531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: