Shelly Marie Kvamme, PT, DPT

Primary specialty

Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X

License

PT00009393 Issued in WA

Practice address

15510 1St Ave NE
Duvall, WA 98019-6000

Phone

(206) 920-2111

NPI assigned

Jul 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1564185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564185600000",
    "number": "1508410663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12703 217TH ST SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982963906",
            "telephone_number": "206-920-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15510 1ST AVE NE",
            "city": "DUVALL",
            "state": "WA",
            "postal_code": "980196000",
            "telephone_number": "206-920-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KVAMME",
        "first_name": "SHELLY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-27",
        "last_updated": "2019-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "WA",
            "license": "PT00009393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT00009393",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kvammes@rsd407.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "15510 1st Ave NE",
            "city": "Duvall",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980196000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Rehabilitation Medicine Physician in Duvall, WA
• Providers in Duvall, WA by specialty
• Pediatric Rehabilitation Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.