Provider Demographics
NPI:1528740198
Name:SUMRALL, KELSEY (PT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 OAKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8592
Mailing Address - Country:US
Mailing Address - Phone:228-348-0694
Mailing Address - Fax:866-404-9501
Practice Address - Street 1:7521 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8669
Practice Address - Country:US
Practice Address - Phone:601-856-8041
Practice Address - Fax:866-404-9501
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty