Kellie Louise Millan, DPT, SCS

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

PT60723998 Issued in WA

Practice address

2710 E 57TH Ave
Spokane, WA 99223-6678

Phone

(509) 252-2354

NPI assigned

Sep 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kellie Louise Shreve Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Drayer Physical Therapy Mississippi LLC

  • Physical Therapist
  • Crystal Springs, MS
  • NPI 1801333521
  NPD (past)

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1902325848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 E 57TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992236678",
            "telephone_number": "509-252-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 E 57TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992236678",
            "telephone_number": "509-252-2354"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "486 228th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Sammamish",
            "state": "WA",
            "postal_code": "980747209",
            "country_code": "US",
            "telephone_number": "425-836-8444",
            "fax_number": "425-836-8447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 Earl Frye Blvd",
            "address_purpose": "LOCATION",
            "city": "Amory",
            "state": "MS",
            "postal_code": "388215516",
            "country_code": "US",
            "telephone_number": "662-257-4048",
            "fax_number": "662-257-4080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLAN",
        "first_name": "KELLIE",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "DPT, SCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT6382",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60723998",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "WA",
            "license": "PT60723998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "SHREVE",
            "middle_name": "LOUISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan Miles
• Sheri D Miles, LPN
• Tonya Miles
• Milestones Speech and Lauguage Services
• Lindsay D Milks, AUD
• Deborah Ann Millard, LMT NCTMB
• Carolyn C Millen, PHARMD
• Alacia Miller
• Alaura Elizabeth Miller
• Aldona J Miller, CNA

• Sports Physical Therapist in Spokane, WA
• Providers in Spokane, WA by specialty
• Sports Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.