Provider Demographics
NPI:1124331632
Name:DUFFIELD, KELSEY R (PT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:R
Last Name:DUFFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:EITEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:407 BLACK HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3243
Mailing Address - Country:US
Mailing Address - Phone:308-762-6564
Mailing Address - Fax:308-762-3747
Practice Address - Street 1:407 BLACK HILLS AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3243
Practice Address - Country:US
Practice Address - Phone:308-762-6564
Practice Address - Fax:308-762-3747
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist