Individual provider Active NPI

Kelly B Weaver, MD

  • Physical Medicine & Rehabilitation Physician
  • Everett, WA
National Provider Identifier
1295831352
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
MD00038761 Issued in WA
Practice address
1330 Rockefeller Ave
Everett, WA 98201-1684
Phone
(425) 339-5476
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD00038761 WA Primary

Addresses

Primary practice location

1330 Rockefeller Ave
Everett, WA 98201-1684

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3903

Other practice location 1

12911 Beverly Park Rd
Lynnwood, WA 98087-5127
Phone (615) 920-7000

Other identifiers 1

IdentifierTypeStateIssuer
1007095MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207001382 WA Practitioner - Physical Medicine and Rehabilitation 7517154248 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 Physical Medicine & Rehabilitation Current Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
Post-Acute Physicians of Washington PLLC Physical Medicine & Rehabilitation CurrentSince Feb 10, 2025 Accepting new patients
King County Public Hospital District No. 2 CurrentSince Mar 1, 2019 Accepting new patients
King County Public Hospital District No 2 CurrentSince Mar 1, 2019 Accepting new patients
Optum Care Washington PLLC CurrentSince Aug 1, 2010 Accepting new patients
Optum Care Washington PLLC CurrentSince Aug 1, 2010 Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

1303 Pacific Ave
Everett, WA 98201
Phone (425) 339-5419

12039 NE 128th St
Ste 500
Kirkland, WA 98034
Phone (425) 899-1220

12039 NE 128th St
Ste 300
Kirkland, WA 98034
Phone (425) 899-3123

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1295831352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-258-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 ROCKEFELLER AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011684",
            "telephone_number": "425-339-5476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12911 Beverly Park Rd",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980875127",
            "country_code": "US",
            "telephone_number": "615-920-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "KELLY",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "MD00038761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007095",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.