Provider Demographics
NPI:1194972117
Name:COLSON, KELLY LEE (MSPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:COLSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 SUMMER BREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6255
Mailing Address - Country:US
Mailing Address - Phone:502-644-1940
Mailing Address - Fax:
Practice Address - Street 1:5008 SUMMER BREEZE CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6255
Practice Address - Country:US
Practice Address - Phone:502-644-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist