Healthcare Provider Details

I. General information

NPI: 1134499569
Provider Name (Legal Business Name): KELLY JOHN VANHOVE PT, DPT, M.S., ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 ROOSEVELT WAY NE
SEATTLE WA
98115-6613
US

IV. Provider business mailing address

6108 ROOSEVELT WAY NE
SEATTLE WA
98115-6613
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-4977
  • Fax: 206-524-4340
Mailing address:
  • Phone: 206-524-4977
  • Fax: 206-524-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA1 60256210
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60745535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: