Provider Demographics
NPI:1902325848
Name:MILLAN, KELLIE LOUISE (DPT, SCS)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:LOUISE
Last Name:MILLAN
Suffix:
Gender:F
Credentials:DPT, SCS
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LOUISE
Other - Last Name:SHREVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 E 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6678
Mailing Address - Country:US
Mailing Address - Phone:509-252-2354
Mailing Address - Fax:
Practice Address - Street 1:2710 E 57TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6678
Practice Address - Country:US
Practice Address - Phone:509-252-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6382225100000X
WAPT60723998225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist