Active NPI
Kelly Jean Anderson, P.T.
- Physical Therapist
- Bothell, WA
National Provider Identifier
1992041198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00009237
- Practice address
- 3330 Monte Villa Pkwy
Bothell, WA 98021-8972 - Phone
- (425) 408-6000
- NPI assigned
- Dec 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00009237 | WA | Primary |
Addresses
Primary practice location
3330 Monte Villa Pkwy
Bothell, WA 98021-8972
Mailing address
19309 127TH Ave NE
Bothell, WA 98011-2502
Phone (206) 316-0658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00009237 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355702400000",
"number": "1992041198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19309 127TH AVE NE",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980112502",
"telephone_number": "206-316-0658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3330 MONTE VILLA PKWY",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980218972",
"telephone_number": "425-408-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-17",
"last_updated": "2012-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00009237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.