Provider Demographics
NPI:1326873837
Name:HALES, KELSEY BROOKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:HALES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 CASH RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-9718
Mailing Address - Country:US
Mailing Address - Phone:678-986-5997
Mailing Address - Fax:
Practice Address - Street 1:209 COOLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-7057
Practice Address - Country:US
Practice Address - Phone:770-917-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist