Provider Demographics
NPI:1386426732
Name:KAPSAR, KELLY (MT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KAPSAR
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 E SUNSET RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3517
Mailing Address - Country:US
Mailing Address - Phone:702-586-5060
Mailing Address - Fax:702-463-7377
Practice Address - Street 1:2560 E SUNSET RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3517
Practice Address - Country:US
Practice Address - Phone:702-586-5060
Practice Address - Fax:702-463-7377
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.345225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist