Provider Demographics
NPI:1487699278
Name:CELSO, JENNIFER E (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:CELSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 3951
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3951
Mailing Address - Country:US
Mailing Address - Phone:316-685-0559
Mailing Address - Fax:316-685-0455
Practice Address - Street 1:551 N HILLSIDE ST
Practice Address - Street 2:STE 510
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-685-0559
Practice Address - Fax:316-685-0455
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200257560AMedicaid
140665Medicare ID - Type Unspecified
KS200257560AMedicaid