# NORTHWEST SPORT AND SPINE PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northwest Sport and Spine Physical Therapy-Mt Vernon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487158259
- **Authorized official:** SEAN O'KELLEY BS, DPT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (360) 464-4358

## Contact information

- **Practice address:** 17788 147TH ST SE, MONROE, WA 98272-1030
- **Practice address phone:** (360) 464-4358
- **Mailing address:** 17788 147TH ST SE, MONROE, WA 98272-1030
- **Mailing address phone:** (360) 464-4358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | PT60693079 | WA | Yes |

## Other

- **Enumeration date:** 03/19/2018
- **Last updated:** 03/19/2018