Provider Demographics
NPI:1215303052
Name:SIKES, KELCI PAGE (PT)
Entity type:Individual
Prefix:
First Name:KELCI
Middle Name:PAGE
Last Name:SIKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELCI
Other - Middle Name:PAGE
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 LAKE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4982
Mailing Address - Country:US
Mailing Address - Phone:979-258-7228
Mailing Address - Fax:979-258-7247
Practice Address - Street 1:210 LAKE RD STE 500
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4982
Practice Address - Country:US
Practice Address - Phone:979-258-7228
Practice Address - Fax:979-258-7247
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1263156OtherSTATE LICENSE