Healthcare Provider Details

I. General information

NPI: 1962195586
Provider Name (Legal Business Name): MARIE KYLEE MANON SETO-HERR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 BOYER AVE
WALLA WALLA WA
99362-2047
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE 100
PORTLAND OR
97222-4628
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-6463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70102748
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number64969
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: