Provider Demographics
NPI:1063979557
Name:SHUMWAY, KELSEY (DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 S MALL DR STE B3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4945
Mailing Address - Country:US
Mailing Address - Phone:435-767-1252
Mailing Address - Fax:435-256-8664
Practice Address - Street 1:446 S MALL DR STE B3
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4945
Practice Address - Country:US
Practice Address - Phone:435-767-1252
Practice Address - Fax:435-256-8664
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11717218-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist