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General NPI Number Information
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NPI Number | 1972051407
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Entity Type | Individual
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Provider Name | KELLY JEAN MCGIVERN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 6710 108TH AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98033-7050
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Country | US
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Telephone | 425-979-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 11001 NE 65TH ST
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City | KIRKLAND
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State | WA
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Zip | 98033-7117
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Country | US
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Telephone | 206-818-8137
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Fax |
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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 | 60667624
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License Number State | WA
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