Individual
KELSEY MARIE LAVAUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT61188988
WA
2251X0800X
Orthopedic Physical Therapist
63665
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500784275
—
OR
01
—
63665
PT LICENSE
OR
Enumeration date
09/09/2020
Last updated
06/16/2021
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