Provider Demographics
NPI:1316457260
Name:CONSTABLE, KELLY ELAINE (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELAINE
Last Name:CONSTABLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1905 SE 192ND AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7415
Mailing Address - Country:US
Mailing Address - Phone:360-210-5440
Mailing Address - Fax:360-210-7731
Practice Address - Street 1:900 NE 139TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2519
Practice Address - Country:US
Practice Address - Phone:360-573-3611
Practice Address - Fax:360-573-3880
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61190260225100000X
OR63834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist