Provider Demographics
NPI:1427593813
Name:SCHAUB, KELSEY (DPT, PT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SCHAUB
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SW 4TH AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5533
Mailing Address - Country:US
Mailing Address - Phone:971-420-3301
Mailing Address - Fax:
Practice Address - Street 1:1720 SW 4TH AVE APT 413
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5533
Practice Address - Country:US
Practice Address - Phone:971-420-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015498225100000X
CA43487225100000X
NM4646225100000X
AZ11992225100000X
WACP012030T225100000X
OR63694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist