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General NPI Number Information
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NPI Number | 1316457260
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Entity Type | Individual
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Provider Name | KELLY ELAINE CONSTABLE DPT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 900 NE 139TH ST STE 102
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City | VANCOUVER
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State | WA
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Zip | 98685-2519
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Country | US
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Telephone | 360-573-3611
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Fax | 360-573-3880
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Provider Business Mailing Address
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Address Line | 1905 SE 192ND AVE STE 109
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City | CAMAS
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State | WA
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Zip | 98607-7415
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Country | US
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Telephone | 360-210-5440
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Fax | 360-210-7731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61190260
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 63834
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License Number State | OR
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