Provider Demographics
NPI:1215429840
Name:CARTAYA, KELSIE (DPT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:CARTAYA
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 1:1003 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1829
Mailing Address - Country:US
Mailing Address - Phone:608-393-3665
Mailing Address - Fax:
Practice Address - Street 1:1101 E SOUTH RIVER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-2223
Practice Address - Country:US
Practice Address - Phone:929-830-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist