Provider Demographics
NPI:1689484065
Name:HOWARD, KELSEY ROSE (PT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ROSE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SE 8TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3497
Mailing Address - Country:US
Mailing Address - Phone:503-208-4360
Mailing Address - Fax:503-200-1148
Practice Address - Street 1:1215 SE 8TH AVE STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3497
Practice Address - Country:US
Practice Address - Phone:503-208-4360
Practice Address - Fax:503-200-1148
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist