Provider Demographics
NPI:1326888694
Name:HROMISIN, KELCIE
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:
Last Name:HROMISIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:570-550-0168
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:DALLAS ROUTE 309
Practice Address - Street 2:SUITE 63
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1231
Practice Address - Country:US
Practice Address - Phone:570-310-1881
Practice Address - Fax:570-310-1886
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23164225100000X
PAPT032052225100000X
MA27561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist