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NPI Code Detail

MEDICARE: KELLY JEAN MCGIVERN PT, DPT

MEDICARE: KELLY JEAN MCGIVERN PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist60667624WA

General Provider Information

NPI Number : 1972051407
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JEAN MCGIVERN PT, DPT
Provider Business Mailing Address
First Line : 11001 NE 65TH ST
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-7117
Country : US
Telephone Number : 206-818-8137
Fax Number :
Provider Business Practice Location Address
First Line : 6710 108TH AVE NE
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-7050
Country : US
Telephone Number : 425-979-7445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2016
Last Update Date : 09/13/2016

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Directions to “ KELLY JEAN MCGIVERN PT, DPT” Practice Location

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