Provider Demographics
NPI:1972959112
Name:KELSEY WEILAND LMP
Entity type:Organization
Organization Name:KELSEY WEILAND LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-742-4328
Mailing Address - Street 1:11117 149TH AVE CT KPN
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5358 33RD AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1773
Practice Address - Country:US
Practice Address - Phone:253-853-7580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60096383302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization